CORE LIST EQUIPMENT ASSESSMENT, PRESCRIPTION, DEMONSTRATION & FITTING OF EQUIPMENT

Transcription

1 TRAINING MANUAL CORE LIST EQUIPMENT ASSESSMENT, PRESCRIPTION, DEMONSTRATION & FITTING OF EQUIPMENT National Association Equipment Providers Scottish Regional Group: Training Sub-Group October 2012

2 JOINT TRAINING ASSESSMENT, PRESCRIPTION, DEMONSTRATION, & FITTING OF EQUIPMENT JOINT PROTOCOL CORE STOCK LIST CONTENTS Section 1 Background information Equipment List Principles of Assessment and Duty of Care Factors for consideration during assessment including Eligibility Criteria General advice General guidelines for use of equipment Section 2 Equipment information Specific considerations or contra-indications for the provision of Core stock equipment Guidance on the prescription of non-core products - Local arrangements should be observed Appendices Appendix 1 - Sample introduction to Training Session Power Point Presentation Appendix 2 - Sample Training Programme Appendix 3 - Sample post Training Evaluation Form Appendix 4 - Outcome Assessment Criteria For Managers information Appendix 5 - Guidance for the training of Trainers Appendix 6 - Infection Control Guidelines Appendix 7 - Guidelines for good practice in maintaining skin integrity in the context of equipment provision Appendix 8 - Orthopaedic Chairs Appendix 9 - Small equipment used in Reablement or Rehabilitation interventions only Appendix 10 - Lifting poles Appendix 11 - Complex Mobile Shower / Toileting Commode Chairs Page 1 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

3 SECTION 1 - Index CORE LIST OF EQUIPMENT COVERED IN THIS MANUAL N.B. It must be noted that different Local Authorities provide different categories/ranges of equipment and local agreements must be observed TOILETING Size and/or type Page Raised Toilet Seat 2, 4 and 6 7 Toilet Frame Free standing, Floor fixed (standard and wide) 8 Combined Toilet Seat and Frame Free standing Floor fixed (standard and wide) 9 Commodes Static height/adjustable/ removable arms 10 BATHING Bath Board/ Shower Board Standard and ex-wide. 26 /27 /28 12 Bath Seat Medici 12 /8 /6 11 Shower Stool Various 13 Shower Chair (static and standard mobile) 13 Swivel Bather 14 Powered Bath Lifts Riviera Style 15 HOUSEHOLD/ GENERAL Trolley Metal and Etwall styles 17 Zimmer Caddy 18 Perching Stool without back and arms 19 with back and/or arms (standard/ex-wide) Food Preparation/ Eating/Drinking/ Various Generally only prescribed by Appendix 9 Washing/Dressing Re-ablement and Rehabilitation teams Grab Rails Local arrangements for fitting apply 20 CHAIRS Chair raising blocks Various 25 Orthopaedic chairs Local agreements for provision Appendix 8 BEDS Bed Raising Blocks 25 Bed Levers/ Rails 26 Mattress Elevators 27 MOBILITY Local arrangements for provision apply Walking Sticks 40 Walking Frames standard 41 Walking Frames wheeled 41 MOVING AND HANDLING Profiling Beds /Standard Mattress /Cot Sides Lifting Poles Not commonly prescribed due to limitations. Appendix 10 Slip Sheets 31 Transfer Turntable 32 Patient Turner with Pedestal 34 Transfer Boards 36 Stedy/ Cricket 35 Stand Aid 37 Mobile Hoist 38 Slings 39 Page 2 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

4 PRINCIPLES OF ASSESSMENT AND DUTY OF CARE Assessment should be carried out by an assessor who is deemed competent by their manager to carry out the necessary assessment and has the knowledge to decide on the appropriate equipment. A range of staff employed within services and agencies e.g. Social work, NHS, Homecare, Housing,can assess the equipment needs of those with a variety of disabilities and conditions in order to effectively meet service users needs. Use of the information in this training manual related to the assessment and provision of specific equipment should be viewed in the context of local arrangements and protocols. The training manual will be used as guidance for the practitioner, and will be supported by manufacturer guidelines [available on manufacturer s websites or via the store] and by ongoing training opportunities. Staff are responsible for ensuring they are conversant with the application of the products in practice and that they fully understand the user instructions supplied as a guide. Interpretation of the information is each assessor s responsibility and must be applied with a specific service user in mind. This may mean that they need to be amended to ensure safe usage for the service user. It must be remembered that Store Core stock catalogue products can change due to procurement activity, and that different versions of a similar product may have slightly different user instructions. Staff must source correct user instructions as required. Store staff and product websites can assist in this. On conclusion of the assessment, and within the range of recommendations made by the Assessor, the Service User s and Carer's wishes will be fully taken into account. The Assessor will only act on those recommendations, which meet with the their approval, ensuring that they understands exactly what they are being issued with, what the equipment is to be used for and establish that they are happy to use equipment. The principal of MINIMAL INTERVENTION, MAXIMUM INDEPENDENCE shall underpin every assessment. Alternative methods of managing have been tried and found not to be successful. Preference alone must in no way influence the type of provision On completion of the assessment, equipment can be ordered through the local store ordering system to ensure the service user s immediate needs are met. Any recommendations made are the responsibility of the assessing professional A recommendation for any equipment must be made in conjunction with the relevant agencies agreed priorities. In accordance with the relevant legislation, it is necessary to consider the following factors: Page 3 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

5 FACTORS FOR CONSIDERATION DURING ASSESSMENT Independence Any proposed equipment/adaptation provision must be "necessary and appropriate" and "reasonable and practicable" in order for the disabled person to remain at home {Local Government Housing Act 1989}. Definition Necessary Appropriate Reasonable Practicable A basic need, which cannot be met without equipment/adaptation. The proposed equipment/adaptation must be suitable and effectively meet the need. Must be the most cost-effective way of meeting the need. Technically feasible, given the age and condition of the property. NB: Equipment/Adaptation provisions cannot be recommended that are desirable rather than essential. Assessment The assessment will determine a person's abilities and existing strengths and any provision will reflect this. The purpose of any provision is to increase or maintain the functional independence of people with permanent and substantial disability. The level of provision will also be dependent on their technical feasibility. Whilst independence is the aim, it may be necessary to compromise due to environmental difficulties. In these circumstances, a Service User may be required to accept the need for assistance, instead of full independence. Age/Prognosis Age or prognosis should not be a barrier to the provision of services. To enable the maintenance of a good quality of life for a person with limited life expectancy, a quick response is necessary. The type of adaptation recommended will need to reflect this. Needs of carers a/ family members Consideration must be given to the role and needs of the Carer, Disabled Persons (Services Consultation and Representation) Act 1986 and Carers (Recognition and Services) Act 1995]. Any proposed equipment must improve the quality of care given to the User. It should also alleviate the physical demands and emotional stress experienced by Carers and other family members, where possible. Future use and needs The planned equipment/adaptation provision, should take into account the Service User s current and long term needs, taking a holistic approach. However, often a simple provision can be made providing for current need, where long term need cannot be anticipated. Equipment/Adaptations should not be considered to overcome social or economic problems, e.g. overcrowding, where no disability issues are identified. Medical advice User s written permission should always be obtained prior to seeking medical opinion. Page 4 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

6 Advice should be sought from medical or other professional colleagues, where appropriate, to establish any prognosis, prior to recommending provision of equipment/adaptations. This will allow the Assessor to consider the Service User reaching his/her optimum level of function. Eligibility In terms of Eligibility criteria, services need to confirm eligibility policy within their own Partnerships. Guidance on eligibility can be found in the Scottish Government document Eligibility Criteria A National Framework December Environmental check To ensure that equipment assessed for and considered essential is suitable and appropriate for the home environment an environmental check is essential. This check must be carried out by the assessing professional through a home visit or via information obtained from the individual, carer or other professional involved. The prescription is the responsibility of the assessor. Equipment store responsibilities including delivery and fitting, service and maintenance of equipment Local Arrangements. Need for specialist equipment When a person s essential needs cannot be met from core stock items, agreement can be sought to purchase non-stock equipment. If an assessor identifies the need for a non-stock specialist item of equipment their manager will be required to authorise provision and expenditure. Equipment no longer meeting user s needs or not now required If equipment no longer meets the needs of the person it was prescribed for contact should be made with the appropriate service If equipment is no longer required uplift should be arranged. Equal opportunities The fullest information should be provided to enable service users and carers to be aware of all possible solutions before a decision is made The outcome of the assessment should be documented clearly in case recordings including all reasons and recommendations for provision. Page 5 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

7 GENERAL ADVICE In accordance with the local Protocol, the practitioner, where ever possible, will check the equipment in a timely manner following supply, to ensure that:- The equipment has been fitted correctly, To demonstrate the correct use of the equipment to users and carers Where staff do not feel they have adequate knowledge to complete the training or demonstration they should contact their senior. Ensure that the user tries the equipment in their presence, and is safe in its use The equipment meets the user s assessed needs If the equipment is found not to be suitable, the equipment must be dismantled/set aside, and uplift arranged using the locally agreed procedures. Delivery staff shall issue the relevant Equipment Information Sheet to the user with fitting, using and cleaning instructions. The practitioner should note in their case notes/case file that the equipment has been issued, fitted and demonstrated appropriately Assessors must be aware of the potential differences in the environment between the home and hospital, if the assessment takes place in hospital. There may be circumstances where assessment is carried out non-face to face i.e. over the telephone. Assessors must be aware of the potential risks involved with this process regarding accuracy of information giving or receiving by service users or carers and the effect this could have on equipment provision and service outcomes. GENERAL GUIDELINES FOR THE USE OF EQUIPMENT Staff must:- Ensure equipment is in good condition and report any faults to the equipment service via Local arrangements Always ensure equipment is fitted properly according to manufacturer s instructions. Ensure all clips and screws are securely in place. Check rubber ferrules are in good condition. Ensure equipment is maintained in accordance with manufacturer s instructions. Ensure that legs are set at the same height and are stable. Equipment should not be moved between one user and another- it must always be returned to the store to be cleaned and decontaminated. Ensure equipment is kept clean and check wheels are running smoothly. It is advisable to check Safe Weight Limits for usage as these can change. This is particularly important when users are near the upper weight limit for the product. Also procurement processes can require that stock products may change. Always check the footprint of equipment to ensure it will fit within the designated space. If the equipment requires to be charged, never try to move it while connected to the charger. Page 6 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

8 SECTION 2 SPECIFIC CONSIDERATIONS OR CONTRA-INDICATIONS FOR PROVISION OF CORE STOCK EQUIPMENT RAISED TOILET SEAT 50mm /2, 100mm / 4, 150mm/6 WEIGHT RESTRICTIONS Considerations prior to issue DESCRIPTION The raised toilet seat can be fitted securely by hand to most toilet bowls with three rubbercovered brackets or 2 brackets and a front lip. One piece white molded raised toilet seat, allowing it to be totally immersed for cleaning. A wide frontal area allows easy access for personal cleaning. Deep splash guard for maximum hygiene. Light, robust plastic, resistant to stains and odour. Less flexion in the hips and knees is required for users which makes it easier to sit down or stand up. Maximum User Weight Limit: 190kg (30stones) Check Safe Weight Limits for usage as these can change Will other people in the family require to remove the seat? May require to be used in conjunction with a toilet frame or a grab rail on the wall. When should this equipment be used? When the user requires a higher seat to minimise excessive flexion of hip joints or toilet is too low for them to transfer on/off safely. Easier to accommodate in small bathrooms than frames. Contra Indications for use Raised toilet seats can reduce the size of the aperture and make toileting more difficult for an individual Some individuals experience problems performing bowel motions with a raised toilet seat Ensure user s feet are flat on the floor when using the toilet with seat in situ. If seat is too high user can feel unsupported. Unsuitable for people with poor sitting balance unless used with appropriate rails or who have gross restrictions in hip/knee movements Some toilet bowls are non-standard in shape and difficult to fit with a RTS Fitting Please refer to fitting instructions for specific makes/models of RTS. General principles are as follows:- Always check manufacturers instructions, as some knobs turn clockwise and others anti-clockwise Check that the existing WC is of a shape/size that allow safe fitting Lift lid and toilet seat attached to the toilet Turn RTS upside down on a flat surface and loosen fittings to enable it to fit over toilet bowl Turn RTS over and position RTS evenly over bowl with front lip held in position firmly against front of bowl Tighten brackets/adjusting screws to ensure a secure fit on toilet bowl Check RTS is securely in place before putting any weight on it Demonstrate safe transfer to the user. Re-enforce to user that they should not hold on to RTS as a support when getting on and off the seat Observe the user demonstrating the safe use of the RTS Demonstrate removal and refitting of RTS to user/carer and observe them doing same to enable cleaning Checks Prior to use Ensure seat is fitted securely. Can seat be removed and re-fitted for other people s convenience or for cleaning? Recommendations /instructions for use To raise toilet seat to assist independent standing from the toilet: Ensure that correct height of toilet seat is prescribed user should be able to place their feet on the floor when in use Ensure both feet are positioned slightly apart and flat on the floor Lean forward, looking straight ahead Straighten your hips and knees, raising yourself slowly, pushing your weight evenly through both knees and feet Stand up straight and gain your balance fully before stepping forward Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Clean with warm soapy water or detergent with disinfectant. Never use abrasive cleaners RTS should be checked regularly to ensure that brackets remain secure. Page 7 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

9 TOILET FRAME WEIGHT RESTRICTIONS DESCRIPTION Can be used when the user requires the stability of arms to hold onto while lowering and raising from the toilet but doesn t require additional seat height This is an adjustable height steel toilet frame with plastic moulded hand grips for support and comfort. The toilet frame fits around the toilet and can be moved when not in use The frame is height adjustable and the legs are secured by e-clips. Maximum User Weight Limit: 160kg/ 25stones Check Safe Weight Limits for usage as these can change Alternatives: Floor Fixing Frame as required fixing kit available from core stock Bariatric Toilet Frame [freestanding / floor fixing] available from core stock Grab Rail on wall Combined Toilet Seat and Frame see below Wall Mounted Fold Down Rail Used where unable to fix a frame to the floor i.e. if there is wet floor shower or user choice Considerations prior to issue Is there sufficient space around the toilet to accommodate the frame Will other people in the family require to remove the frame Ensure height and width is suitable for user Contra Indications for use If user has only use of one arm the frame can tip if too much pressure is placed on one side - a floorfixing frame may be necessary When a user tends to drop onto the seat a floor fixing frame can be used to keep the frame steady Ensure the frame does not obstruct access to a bath or hand basin or ingress/egress to the bathroom Unusual features of the toilet that might affect fitting equipment e.g. side waste pipes, toilets being raised on small steps, close to a side wall Checks Prior to use Check dimensions of toilet and surrounding area to ensure it will fit Compatibility with other equipment should be ensured Ensure floor fixed frames are securely fitted to floor Ensure frame is set at correct height and that all e-clips are securely in place Can frame be stored safely if it has to be removed for other family members Fitting Equipment Select the height required for user, if necessary adjust as follows:- Place frame on its side and push spring clip out and slide leg to correct height. Ensure spring clip is fully re-engaged and facing inwards Repeat for each leg in turn, ensuring legs are at the same height Double check all legs are secured, at the same height and level on the floor Place around toilet with bars at front Demonstrate safe use of the frame to the user Re-enforce to user that they should use both hands when transferring on/off toilet Observe the user demonstrating the safe use of the frame If it is not possible to fit equipment securely do not leave the equipment with the user but seek advice and/or contact the Equipment Store When using free standing toilet frame with a 2 or 4 raised toilet seat, frame height should be raised by 2 If Free Standing Toilet Frame is being used in conjunction with Raised Toilet Seat, the raised seat must be checked regularly to ensure brackets remain tightly fastened Instructions for use - See information on toilet frames above Maintenance Clean the toilet frame when the toilet is being cleaned. To clean the toilet frame it is recommended to use hot water and a soapy solution or non-abrasive bathroom cleaner. Worn ferrules can be replaced via the equipment store by raising a repair request. Page 8 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

10 COMBINED RAISED TOILET SEAT WITH RAILS DESCRIPTION A Combined Raised Toilet Seat with rails has a cut away seat front, mounted on a height adjustable free-standing frame, which can be placed over the existing toilet to provide a higher sitting position. Armrests provide additional support. The back legs can be adjusted one level higher than the front to angle the seat for a user who cannot flex to 90 at the hip. The existing toilet seat is retained but must be left in the upright position to allow the frame to be fitted securely. WEIGHT RESTRICTIONS Maximum User Weight Limit: 190kg/ 30stones Check Safe Weight Limits for usage as these can change Alternatives Extra Wide combined RTS with rails / Floor Fixing version /Adjustable Width version Where unable to fix a frame to the floor i.e. if there is wet floor shower or user choice, consider use of wall mounted fold down rail. Considerations prior to issue This equipment should be issued when the user requires a higher seat and the stability of arms to hold onto and push up from. Discuss provision with user to :- Check that there sufficient space around the toilet to accommodate the frame? Ask if other people in the family require to remove the frame? The frame can tip if too much pressure is placed on one arm in this case a floor fixing frame is required Can be used when toilet bowls are non-standard in shape and unsuitable for a RTS Legs can be a trip hazard for users Contra Indications for use If user has only use of one arm then a floor-fixing frame may be necessary. Requires adequate sitting balance for safe use. Ensure the frame does not obstruct access to a bath or hand basin Unusual features of the toilet that might affect fitting equipment e.g. side waste pipes, toilets being raised on small steps, close to a side wall. Raised toilet seats can reduce the size of the aperture and make cleaning more difficult for an individual. Some individuals experience problems performing bowel motions with a raised toilet seat. Checks Prior to use The person must be assessed using the equipment, either in the hospital setting or within the home. Fitting Equipment Select the height required for user, if necessary adjust as follows: Place frame on its side and push spring clip out and slide leg to correct height. Ensure spring clip is fully re-engaged and facing inwards. Repeat for each leg in turn. Double check all legs are secure and the same height. Lift lid and seat of toilet and place frame over toilet. All four legs should be stable on the ground and splashguard should be inside bowl but not touching it. Sit on seat and frame to ensure it is stable. Demonstrate safe use of the frame to user. Re-enforce to user that they should use both hands when transferring on/off frame. Observe the user demonstrating the safe use of the frame. If it is not possible to fit equipment securely remove the equipment where possible or arrange uplift and and/or alternative provision... Instructions for use - See for Toilet Frame above Maintenance Clean the toilet frame when the toilet is being cleaned. To clean the toilet frame it is recommended using hot water and a soapy solution or non-abrasive bathroom cleaner. Worn ferrules can be replaced via the equipment store by raising a repair request. Page 9 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

11 COMMODES DESCRIPTION Coated tubular steel frame. Removable plastic pan and lid. Fire retardant upholstered back and detachable seat cover. WEIGHT RESTRICTIONS Weight limit of 25 stones/160kg. Check Safe Weight Limits for usage as these can change Alternatives types Adjustable height/ Detachable arms/ Side transfer/ Bariatric/ Wheeled are available as non-stock orders Considerations prior to issue Positioning/placement of commode regarding user privacy for use A dry level surface is available to position the commode Compatibility issues with other equipment hoists/ wheelchairs etc Height and width are suitable for the user When should this equipment be used? Patient/user unable to access fixed toilet safely due to mobility difficulties at times Frequency of micturition should be referred additionally for medical intervention if appropriate Nocturia user may not be fully alert or orientated To facilitate continence User can transfer on/off safely and use both hands together to push up from frame Requires sufficient safe and private space for use and storage A responsible person is identified and available to empty and clean commode after use Contra Indications for use Poor sitting/functional balance User throws themselves onto the commode which is not floor fixed Weakness/reliance on one side e.g. following CVA. Cannot be supplied unless assistance available to empty/clean Over raising of WC can interfere with normal bowel function and/or circulation User should be able to sit with their feet on the floor Adjustments All 4 legs must be level on the floor. Remove floor mats if necessary. All 4 legs must be adjusted to the same height. Spring clips secure the position Checks Prior to use Optimum finished seat height is calf length measure from back of knee to floor when seated. Maintenance Clean with hot water and a soapy solution or non-abrasive bathroom cleaner Page 10 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

12 BATH SEAT DESCRIPTION Plastic slatted bath seat with suckers on each leg to allow the seat to be secured to the bottom of the bath for stability. WEIGHT RESTRICTIONS The seat comes in 6, 8 and 12 heights. Maximum load of 190kg / 30stones Check Safe Weight Limits for usage as these can change Alternatives Suspended type [non-stock order] Medici type with width adjustable to closely fit internal dimension of the bath 6 / 8 /12 non-stock order Considerations prior to issue Will other people require to use the bath? May be used in conjunction with a bath board Bath seats for acrylic baths must load bear through the base of the bath and not the sides When should this equipment be used? Useful for users who can transfer into the bath but have difficulty rising up from a seated position or have difficulty sitting down fully in the bath. Can be used in conjunction with a shower board and grab rails Contra Indications for use Unsuitable for users with poor balance and with limited range of movement in hips/knees Users will require good upper limb strength to rise from the 6 seat Check skin condition Use with caution following total hip replacement ensure clear instructions are given to prevent flexion beyond 90deg at hip or twisting movements on operated leg It is not advised to be immersed totally in water for some medical conditions i.e. CAPD dialysis, dermatological conditions Users with poor short term memory may forget instructions for use Adjustments Height is static but side fixings should be adjusted to suit width/shape of bath Checks Prior to use Demonstrate safe use of the seat Ensure bath and suckers are dry before fitting to bath Position seat in the bath with back directly in front of the board if used Should be used in conjunction with a non- slip mat (privately purchased) Using equipment Holding onto the side of the bath, board if used, side of the seat and/or the rail gently lower your bottom onto the seat this depends on the user s upper limb strength and ability to use both arms especially using a 6 seat When seated straighten knees so they extend in the bath Before starting to come out of the bath, drain water and then reverse the process Ensure that one or both hands are on the board, side of the bath, or rail prior to transferring from seat to board or standing Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Do not lift up seat without releasing suckers by gently pulling up the release tabs Ensure suckers and seat slats are in good condition and are not cracked Page 11 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

13 SHOWER BOARD / BATH BOARD DESCRIPTION Plastic slatted shower board with brackets underneath to allow the board to be secured tightly against the side of the bath for stability. The boards come in 26, 27, 28 widths and are available. WEIGHT Maximum load of 190kg / 30sts RESTRICTIONS Check Safe Weight Limits for usage as these can change Alternatives Boards with extended/adjustable cleats are available for use on moulded baths. High bath seat [12-13 ] with adjustable edges that create a bridge within the bath at the same level as the bath edge where a ledge is unavailable. Considerations prior to issue Ensure you have ordered the correct width of board for the bath. It should not extend over the edge of the bath as this may cause tipping Can be used in conjunction with a grab rail on the wall to assist turning / balance sitting/ standing under the shower. When should this equipment be used? Shower boards should be used to allow easier transfer in/out of bath to enable user to use an over bath shower in a seated position Can be used with bath seat to allow user to lower into water in 2 easy stages by transferring weight from board to seat Contra Indications for use Unsuitable if a fixed screen is in situ Unsuitable for users with poor sitting balance Users should have enough exercise tolerance, upper and lower limb strength to use safely Check skin sliding on bath/shower boards can cause friction due to fragile/ broken skin Can be unsuitable for fitting in some sculpted baths or those with scalloped tops Standard bath/shower boards may not be suitable for corner baths Use with caution following total hip replacement ensure clear instructions are given to prevent flexion beyond 90 deg at hip or twisting movements on operated leg If bath handles are higher than the side of the bath, this may impede use of bath board Users with poor short term memory may forget instructions for use If user has leg ulcers check with District Nurse whether bathing is permitted Adjustments Only to be fitted to a bath where the lips/edges are at least 1.5 wide Loosen the bracket wing nuts underneath the board and Place board across the bath at the opposite end from taps Adjust brackets to ensure snug fit, and then proceed to tighten wing nuts DO NOT OVERTIGHTEN AS THIS CAN DAMAGE THE BOARD Checks Prior to use Demonstrate safe use of board. Ensure wing nuts are tightened properly they should be checked periodically to ensure they remain tight Should be used in conjunction with a non- slip mat (private issue required) Ensure user /carers are advised on how to fit the bath/shower board and are able to refit it in the correct position Using equipment Turn until bottom faces side of bath with board directly behind you Sit down centrally on the side of the board, with feet on the floor Slide or shuffle backwards on the board, turn and swing legs over the side of bath and reposition yourself into the middle of the board Use OB Shower from this position or lower yourself onto bath seat For people who are unable to, or who are not permitted to bend their hips and knees, ensure board allows enough space for extended legs Be aware of the position of shower head, screen and controls, along with the length of hose and management of shower curtain in relation to the board A bath step and /or wall mounted grab rail can be used when bath is too high if this is appropriate and safe for the user. n.b. There is a possible trip hazard if the bath step blocks the pathway to WHB, WC or door. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Cleaning with hot water and a soapy solution or non-abrasive bathroom cleaner is recommended. Ensure wing nuts remain secure to maintain correct position of the board in use. Page 12 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

14 STATIC SHOWER STOOLS AND SHOWER SEATS Shower Stool/Bench swl 20st Check Safe Weight Limits for usage as these can change DESCRIPTIONS Shower Stool - Adjustable height bench for use in the shower. Heavy duty perforated injection moulded plastic seat clips onto frame and can be removed for ease of cleaning. Static Shower Seat - Shower Chair with arms and back - Adjustable Height Nylon coated all steel welded frame with H section base for added strength. Moulded polypropylene seat with drainage holes. Static Shower Seat - swl 22stones Alternatives Padded shower stool / Corner shower stool /wheeled shower seat standard available in core stock. Shower seats with tilt-inspace mechanism, etc require specialist OT assessment. Considerations prior to issue Space available in the shower area for user as well as equipment particularly seats in shower cubicles? Check shower chair will fit inside shower cubicle before ordering Is the seat large enough to accommodate the user s bottom without getting wedged in? Shower stools with 4 separate legs can pose a risk of puncture in some plastic shower trays Presence of an even surface to stand the equipment on Orientation in the shower area and proximity of shower screens to user s legs Access to shower controls When should this equipment be used? Useful for people who have poor exercise or standing tolerance Medical conditions where fatigue is predominant symptom e.g. MS When dizziness is experienced due to Postural Hypotension and/or users cannot attend to their personal care (e.g. hair washing) whilst standing Contra Indications for use of stools Unsuitable for users with poor sitting balance; not advisable for users with a one sided weakness as stools may overbalance Unsuitable for users with spinal injury, skin/tissue problems or who are very thin/ emaciated Contra Indications for use of seats Unsuitable for users with spinal injury, skin / tissue problems or for those who are very thin / emaciated Use with caution following a total hip replacement: ensure clear instructions are given to prevent hip is not flexed beyond 90 deg. And there are no twisting movements of the operated leg Adjustments and fitting Stool and shower chair are height adjustable with spring clips ensure all legs are adjusted evenly and to the user s requirements Follow manufacturer s instructions to make required adjustments to each leg as required Checks Prior to use Check ferrules in good condition to prevent stool/ seat slipping Check the seat height meets the user s needs Using shower stools Be aware that the short arms are often too low to use during sitting down When getting up the arms must be leaned on with both hands to avoid tipping Often used in conjunction with the grab rail To sit on shower stool Approach the seat and turn to back up until back of knees touch the seat Grip grab rail if used prior to sitting down in a controlled manner To get up Move forward in the seat and lean forward until head is above the knees Leading with the head, push up with the arms and/or legs until upright Take hold of walking aid, with one hand then 2 hands [if used], move away from the chair once standing balance assured Using shower seats To sit on shower chair use standard method for a chair:- Approach the seat and turn to back up until back of knees touch the seat Put hands onto chair arms prior to sitting down in a controlled manner To get up:- Move forward in the seat and lean forward until head is above the knees Leading with the head, push up with the arms and legs until upright Take hold of walking aid if used, with one hand then 2 hands, move away from the chair once standing balance assured Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Page 13 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

15 SWIVEL BATHER DESCRIPTION Allows the user to be seated form the side of the bath and then to swivel over the bath for a wash or shower SWL 16stones/102kg WEIGHT RESTRICTIONS Check Safe Weight Limits for usage as these can change Alternatives Adjustable width swivel bather Swivel bather for corners baths Heavy duty swivel bather for users over 20st/127kg Considerations prior to issue Where a person has more than one washing facility i.e. bath and a shower, equipment will only be offered to facilitate one of these Has the bath enough ledge [minimum 3cm] on either side for the bather to rest on to achieve a safe and secure fitting? Is the user tall enough to sit safely on the seat with feet flat on the floor to stand up? Can the user slide to the back of the seat to position themselves ready to use the bather or slide forward to facilitate standing up? When should this equipment be used? The service user is unsafe transferring in/out of the bath independently A strip wash is unsafe or inappropriate Carer assisting service user is unable to do so safely and a manual handling risk has been identified The service user has been assessed with a bath board and cannot transfer safely into the bath Service user requires additional back support The service user should have adequate hip mobility to facilitate safe use of equipment Contra Indications for use A secure and safe fitting cannot be achieved The service user cannot demonstrate a safe transfer using the equipment The service user is confused The service user has a medical condition that could put them at increased risk when using the equipment The service user exceeds the recommended size or weight limit Fitting Rest the base frame securely on the bath. At least 1¼ inch (30mm) of each arm must rest on the sides of the bath. Turn the positioning screws on both sides until the black rubber ends are just touching the sides of the bath. There should be no lateral movement while in use Place the seat on the base frame. The socket under the seat locates over the swivel pin of the base frame. Ensure that the seat rotates freely. Lock the seat by pushing the black knob on the locking lever gently down until the lock locates in the slots in the base frame Checks Prior to use Check manufacturer s guidelines when fitting bath equipment to acrylic baths Swivel bathers are generally used in conjunction with an over bath shower Careful consideration should be given to supplying bathing equipment to service users using oils or emollients in the bath as both safe transfers and safe fitting of equipment may be compromised Recommendations /instructions for use Swivel the seat to face the side of the bath and lock into position - The user can now be seated Unlock the seat by lifting the locking lever and transfer legs over the side of the bath. Lock the seat when over the bath for extra security while washing or showering Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Page 14 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

16 POWERED BATH LIFT DESCRIPTION A Bath Lift enables the service user to enter and exit the bath and to bathe in a semi - reclined position. WEIGHT RESTRICTIONS SWL 140kg/22 stones Check Safe Weight Limits for usage as these can change Considerations prior to issue The service users has a need to be immersed in the bath for definable medical reasons as confirmed by the Nurse or GP. e.g. skin conditions, persistent incontinence, chronic urinary tract infections or terminal illness [palliative care stages] Where a person has more than one washing facility i.e. bath and a shower, equipment will only be offered to facilitate one of these Is the user tall enough to sit safely on the seat with feet flat on the floor to sit down or stand up? Can the user slide to the centre of the seat if required then swivel while lifting their legs [or being assisted to do so] over the bath side to position themselves to use the bather? Is the bath strong enough to support the bath lift and the user s weight? Is the bath long enough to accommodate the bath lift with the user sitting on it? Can the user operate the handset safely if using independently? When should this equipment be used? A strip wash is unsafe or inappropriate The service user has been assessed with a bath board/seat/ rails/ swivel bather and cannot transfer safely into the bath Carer assisting service user is unable to do so safely and a manual handling risk has been identified Service user requires additional back support The service user/carer demonstrate a safe transfer using the equipment The service user should have adequate hip mobility to facilitate safe use of equipment There is sufficient space in the home environment to use and store the bath lift safely Contra Indications for use The service user can manage with simple equipment A secure and safe fitting cannot be achieved The service user has sensory loss and there is risk of limb/ fingers/ genital entrapment without awareness The service user is confused The service user has a medical condition that could put them at increased risk when using the equipment The service user exceeds the recommended size or weight limit The carer is unable to raise the bath lift in and out of bath, if removal is necessary. The service user is unsafe transferring in/out of the bath independently The service user is unpredictable in their behaviour/weight bearing abilities The service user and/or the carer has a cognitive impairment or for other reasons cannot safely and consistently operate the equipment or follow procedures for charging the battery Fitting Make sure that the bottom of the empty bathtub is clean. Remove any non-slip mats from the bathtub Insert the seat frame into the empty bathtub. The rear suction cups should be located at the bevelled edge of the bathtub Press down the suction lever of the front mid suction cup. This automatically adjusts the mid suction cup to the bottom of the bathtub and fixes it into position Place the backrest with cover on the frame in the bathtub. Then insert the guide pins of the backrest into the bearing blocks of the frame Attention: Always make sure that both guide pins are inserted in the bearing blocks! Take the manual control lever in one hand and pull it away from the lift until the cable is slightly tensioned Take the hand grip with the other hand and fold up the backrest until it reaches the stop position of the base-plate Insert the storage battery in the battery compartment having ensured that is fully charged. Ensure that the side flap protectors are in position in baths with handles at the side. They act as guide rails preventing the flaps from getting forced under the bath rails when the lift is ascending. Page 15 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

17 Checks Prior to use Check manufacturer s guidelines when fitting bath equipment to acrylic baths Careful consideration should be given to supplying bathing equipment to service users using oils or emollients in the bath as both safe transfers and safe fitting of equipment may be compromised Arrangements for regular appropriate cleaning on site are made Recommendations /instructions for use Ensure that all safety checks have been carried out before each use The handler should always familiarise themselves with the operation instructions and safety precautions before using the bath lift The handler should always use the bath lift according to the manufacturer s instructions A suitable and sufficient risk assessment should be performed to ensure that the hoist is suitable for the intended task and to determine whether it is necessary Do not operate the bath lift unless the handler is trained and competent to do so Ensure that the emergency stop and lowering machine is working prior to use Ensure that the manual accompanies the bath lift at all times Bath lift may require regular charging so would require access to a convenient power point, if the batteries cannot be removed from the bath lift Getting on and off the bath lift Turn until bottom faces side of bath with bath lift seat [flaps down]directly behind you Sit down centrally on the side of the seat, with feet on the floor Slide or shuffle backwards on the seat, turn and swing legs over the side of bath and reposition yourself into the middle of the seat For people who are unable to, or who are not permitted to bend their hips and knees, ensure seat position allows enough space for extended legs Using the handset to control the Bath Lift The handset has an on button and an emergency stop button, control lamp which indicates the status of the battery charge when the on button is activated. Up and down buttons control the movement of the lift. GREEN Lamp: Lift is ready for operation. YELLOW Lamp: Limited readiness for operation (sufficient power for just 1 more bath). - The battery should be charged now. RED Lamp: The lift is no longer ready for operation and will only move upward for leaving the bath. - The battery must be charged now. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Page 16 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

18 WALKING TROLLEY DESCRIPTION Adjustable height trolley made of robust, all welded plastic coated steel, with angled sides to provide safe hand grips and instil user confidence. The strong shelves are plastic injection moulded and each has a continuous lip, designed for spill containment, The bottom shelf is set forward for ease of walking and dining. This product DOES NOT HAVE BRAKES. WEIGHT RESTRICTIONS Maximum User Weight Limit: Depends on Model Check Safe Weight Limits for usage as these can change. Criteria for use Medical User has walking aid which requires use of both hands User has severe upper and/or lower limb tremor User has severe upper limb deformity which poses a risk in the transporting of small items Environmental The user is unable to eat in their kitchen due to lack of table and chair or space for table and chair in the kitchen and is unsafe when carrying food to an appropriate eating area The user requires assistance to transfer hot dishes from a cooking appliance to a safe surface in the kitchen Measuring Dimensions The user should be able to maintain an upright posture with elbows slightly bent when holding onto the handles on the trolley When ordering, specify finished height required from floor to lip of top tray. This will be approx 7 below the height of the handle, mid point on the trolley Alternatives This trolley is NOT a walking aid - if a user requires the support of a walking frame then a referral should be made to Community Physiotherapy Etwall trolley for those using only 1 hand to push the trolley Buckingham Caddy - for a user who uses a walking frame, the caddy fits onto the walking frame and enables the user to carry most items safely Considerations prior to issue Has the user unpredictable mobility e.g. shuffling or accelerating gait? May be unsuitable for users with heavy reliance on walking aids? Useful for users with severe upper and/or lower limb tremor Useful for users with severe upper limb deformity which poses a risk in transporting of small items It is essential to check that there is space for the trolley to move freely within rooms, pass between rooms safely, and move smoothly on floor coverings. Hard floors offer no resistance so users must be able to control the speed safely If necessary remove loose rugs or lower door thresholds A piece of non- slip matting or Dycem mat may be issued on the tray to prevent items slipping The above type requires 2 hands to push. See alternative trolley for 1 handed usage [Etwall trolley] Adjusting the height The trolley has 4 large 100mm castors as standard and a range of adjustment heights from about Height can be adjusted by removing locking spring clips and setting legs to required height and then securing spring clips in position. The shelves clip on/ clip off feature facilitates ease of cleaning and re-issue Maintenance Equipment should be cleaned in accordance with manufacturer recommendations No hot pans or casseroles should be placed on shelves Ensure wheels are running freely and properly inserted into the trolley legs Page 17 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

19 WALKING AID / BUCKINGHAM CADDY DESCRIPTION A Buckingham caddy can be fitted to a standard walking frame. The flat tray top allows the user to carry items from A to B including plates and cups. The deep internal basket can be used to carry various other items as required. When should this equipment be used? A Buckingham caddy can be considered in preference to a trolley wherever this is suitable A Buckingham caddy may be more suitable than a trolley where extra stability is required Considerations The caddy may be awkward if the user takes their walking aid out and about The caddy mustn t be overloaded as this could de-stabilise the walking aid Should be fitted and maintained in according to manufacturer s instructions NB: Caddy does not fit all styles of walking frame (particularly those with a double cross piece at the top). Page 18 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

20 PERCHING STOOL DESCRIPTION Sturdy, stable stools with padded foam seats. The frames are lower at the front to allow the seat to slope. Legs are widely spaced for stability and have large rubber feet to prevent slipping. Leg height is generally adjustable over 150mm (6ins) without tools. WEIGHT RESTRICTIONS Alternatives types Check Safe Weight Limits for usage as these can change. Stool - no arms or back Stool - with arms and/or back Bariatric and ex-wide versions available (SWL up to 40stones). When should this equipment be used? To assist where there is reduced standing tolerance, chronic fatigue, pain or general debility Perching stools can be very helpful in conserving energy and maintaining independence Perching stools position the user in a semi-standing position. They have a sloping angled seat and are suitable for people who can take some of their weight through their legs. Because of the semi- standing position, less leg room is required and the user can get closer to whb enabling them to wash and carry out other personal hygiene tasks. Useful for any tasks which require to be carried out at kitchen work surface and other household tasks such as ironing Provision would support functional ability The user can stand to transfer on/off safely Contra Indications for use Can be too high for very short people May not be suitable for people with painful knees Splayed legs can be a trip hazard Not for use in shower always supply shower stool Is user capable of ensuring stool is used correctly? If they try to sit on it the wrong way round this can result in a fall Requires sufficient floor space, as legs are wide for stability Work surfaces require to be a suitable height for seated food preparation Consider needs/heights of other household members Can the user move it out of the way if required? Checks Prior to use Ensure stool is set at correct height and that all spring clips are securely in place Ensure all rubber ferrules are in place and not perished Check there is adequate space to use stool and that it will not be a trip hazard Can stool be stored safely? Fitting Leg height adjustment:- Remove spring clip from the extension leg and extend all legs evenly to the desired height ensuring they so not exceed the last punched hole of the extension leg Once desired height is achieved re-install the e-clip ensuring that it has passed through the extension leg and that it is fitting neatly and snug around the outside leg The perching stool is designed to slant to the front. Do not adjust the legs to make the seat even as this will compromise the safety of the user The users feet should be resting on the floor When using perching stool with arms or arms and back, user must use both hands when rising from stool Measuring dimensions As seat is elevated, to allow the user to perch, it will be higher than standard seat height/calf length Measure from back of knee to floor, when seated and add approx 3-4 for supply height. The user should then be assessed with the perching stool, and adjusted as necessary This product requires a check home visit to ensure correct height and safety Hospital based staff must assess user within hospital/assessment environment before requesting equipment. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Worn ferrules can be replaced via the Equipment Store by raising a repair request Page 19 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

21 GRAB RAILS DESCRIPTION Epoxy Coated tubular steel or PVC rails WEIGHT RESTRICTIONS: Capacity will be affected by the weight of the user and the surface to which the rail is applied. See Website for specific Safe Weight limits for each rail. Alternatives types Short rails 12 / Long rails 18 / 24 /36, angled with fluted surface/ Newel [which curves 90 degrees around the newel post on a staircase/right or left]. Alternative provisions Toilet frame/ Drop down rail [wall or floor mounted]/ Swedish rail by baths/ Half Surrey rail by toilets/ additional section of banister. Considerations prior to issue For use indoors or outdoors, bathroom or stairs? type of rail will vary Purpose to be used pushing, pulling, leaning on What type of surface will it be attached to? User visually impaired and requiring contrasting rail When should this equipment be used? Users with weakness in the legs when upper limb will lift the body Users with poor balance To aid safe transfers Difficulty negotiating the turn of the stairs where treads are narrow Can be used for support where space is limited for a walking aid e.g. internal steps or narrow access to bathroom Contra Indications for use Severe visual impairment where users cannot discern figure and ground Not to be used as an alternative to correct use of a walking aid Metal grab rails should not be fitted in bathrooms as they do not provide adequate grip Points to consider during assessment Wall should have capacity for safe fixing. Technical advice should be sought from the contractor or building officers where required and appropriate Access to door lock and handle should not be obstructed by the fitting of the grab rail Should be sufficient space between rail and the wall to allow user to grasp the rail firmly Only fluted PVC rails should be used in bathroom Can be used in conjunction with bathing equipment to provide additional support Bilateral rails should be considered where there is weakness in one side or reduced grip strength or a need to avoid twisting trunk For floor fixed rails consider type of flooring e.g. wet floor area could result in water ingress For drop down rails consider lateral pull by users which could loosen fixings Measuring dimensions Rail should be positioned at a suitable height to enable the user to grasp safely and avoid overreaching while mobilising in either direction. Fitting is user specific. It can be fitted horizontally, vertically or diagonally Wall should be marked with sticky dots, a description, diagram or specifications provided to the contractor If the newel post is on the left ascending order a left newel rail If the newel post is on the right ascending order a right newel rail Maintenance Rails can be cleaned with a warm soapy solution Should be checked regularly to ensure fixings are secure Epoxy coated steel rails can become rusted when exposed to water which could cause risk of skin damage when used. These should be replaced Page 20 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

22 GRABRAILS - INSTRUCTIONS FOR THE FITTING The following specification information should be used to detail requirements for the type, and positioning of the grab rails. The grab rails will be fitted by relevant local services/technical staff following prescriber s specification PRECAUTIONS/CONTRAINDICATIONS Concerns about suitability of surface for fixing of grab rail should be discussed with technician. SPECIFICATION FOR THE FITTING OF GRAB-RAILS The following specifications are derived from Designing for the Disabled by Selwyn Goldsmith, RIBA Publications Ltd. 1. Positioning of grab-rail at toilet: Specification 1a A grab-rail of minimum length 40cm should be used. The rail should be fitted in horizontal position. The rail should be fitted at a height of 22.5cm above the level of the toilet seat. If a raised toilet seat is used, this height must be taken from the level of the raised toilet seat when fitted on the toilet. The mid-position of the rail should lie at the line of the front of the toilet seat. A variation of 5cm horizontally/vertically is allowable in achieving this specification. 2. Positioning of grab-rail at toilet: Specification 1b An inclined rail may be preferred where the rail is used to assist in pushing from seated to standing position. A grab-rail of minimum length 50cm should be used. The rail should be fitted at an angle of 15 degrees. The lower end of the rail should be fitted at a height of 22.5cm above the level of the toilet seat. If a raised toilet seat is used, this height must be taken from the level of the raised toilet seat when fitted on the toilet. The lower end of the rail should lie 20cm in front of the line of the front of the toilet seat. A variation of 5cm horizontally/vertically is allowable in achieving this specification. Page 21 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

23 Positioning of grab-rail at bath: General Information Rails for use in conjunction with a bath should have a textured finish to enhance grip. Grab-rail for hand-support when sitting on floor of bath, or on bath seat without bath board: Specification 2a Rail length 60cm is recommended. Rail should be fixed in horizontal position. Rail should be fixed at height of 10cm from rim of bath. Rail should be fixed fro 30-90cm from head of bath. A variation of 5cm horizontally/vertically is allowable in achieving this specification. 3. Grab-rail for hand-support when sitting on bath or shower board: Specification 2b Rail length 40cm is recommended. Rail should be fixed in horizontal position. Rail should be fixed at height of 22.5cm above the level of the bath/shower board. The mid-position of the rail should lie in line with the front of the shower board. A variation of 5cm horizontally/vertically is allowable in achieving this specification. Page 22 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

24 4. Grab-rail to assist sitting/standing from bath/shower board: Specification 2c Rail length 60cm is recommended. Rail should be fixed in vertical position. Rail should be fixed at height of cm from floor. Rail should be fixed 30cm from line of edge of bath. A variation of 5cm horizontally/vertically is allowable in achieving this specification. 5. Grab-rail at over-bath shower, for use in standing position: Specification 2d Rail length 60cm is recommended. Rail should be fixed in vertical position. Rail should be fixed at height of cm from floor of bath. Rail should be fixed 40cm from foot of bath. A variation of 5cm horizontally/vertically is allowable in achieving this specification. Positioning of grab-rails at level-access shower: General Information Rails for use in conjunction with a shower should have a textured finish to enhance grip. 6. Grab-rail to assist stepping in/out of shower area: Specification 3a Rail length 40cm is recommended. Rail should be fixed in vertical position. Rail should be fixed at height of cm from floor. Rail should be fixed above the line of edge of access to showering area. Page 23 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

25 A variation of 5cm horizontally/vertically is allowed in achieving this specification. 7. Grab-rail to assist access to shower seat: Specification 3b Rail length to be specified by Occupational Therapy staff. Rail should be fixed in horizontal position. Rail should be fixed at height of 100cm from floor. Rail should be fixed on wall between access to showering area and shower seat. A variation of 5cm horizontally/vertically is allowable in achieving this specification. 8. Grab-rail to assist standing at shower: Specification 3c Rail length 60cm recommended. Rail should be fixed in vertical position. Rail should be fixed at height of cm from floor. Position of rail in relation to shower controls or shower seat to be specified by Occupational Therapy staff. A variation of 5cm horizontally/vertically is allowable in achieving this specification. 9. Grab-rail fitted externally at Front Door: Specification 4 Rail length 40cm is recommended. Rail should be fixed in vertical position, at the opening side of the door. Rail should be fixed at height of cm from top step. Rail should be fixed on the door frame in a position not less that 5cm from the door surface. The position of the rail should not obstruct access to, or use of, the door handle and door lock. A variation of 5cm horizontally/vertically is allowable in achieving this specification. Page 24 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

26 CHAIR CHAIR AND AND BED BED RAISERS RAISERS DESCRIPTION Chair/ bed raising units that attach to legs or castors and raise the chair height 2 to 6 higher. A B Maximum raise for beds is 5 with standard equipment. 500kg/ 78stones [including the weight of the chair/ bed / couch] Check Safe Weight Limits for usage as these can change. Alternatives Consider alternative seating/bed already available in the home Firm cushion suitable for some chairs depending on seat base dimension and height of the armrests (private supply required) Replace chair/bed with one of a higher seat/bed base height An assessment may be needed for a more specialist chair Height adjustable bed for use of multiple carers Considerations prior to issue Are the chair /bed legs suitable to attach the raising unit to? Bed corners don t inhibit use of the raisers Unit A can only accommodate slim cottage style legs Unit B can take legs/feet up to 4 in diameter Requires sufficient space to position the chair, settee or bed on the raising unit When used for beds or settees each unit will accommodate 2 legs i.e. 6 legs require 3 units When should this equipment be used? To assist where the user has:- Difficulty rising from or controlling their descent into a chair or settee. This can be due to restricted joint movement, weakness or general debility When a bed requires to be raised for using a hoist [minimum clearance 5 from the floor] The need to raise a bed in order to achieve a safe working height for a sole carer Contra Indications for use Where the user would be put at risk through their inability to stand safely or mobilise away from a chair or settee even with assistance Method of transfer e.g. unevenly leaning heavily to one side Beds or chairs are in an unsafe condition Beds without feet or castors Unsuitable for Profiling, height adjustable or Adjustamatic beds Unsuitable for riser/recliner or riser only chairs Adjustments Chair/ bed/ couch must not be moved with the raiser unit attached Measuring dimensions Optimum finished height is calf length - measure from the back of the knee to the floor when seated User s feet should still be able to be placed flat on the floor when sitting after the raise is fitted Checks Prior to use Over-raising of seating can adversely affect circulation Chair or settee should not be moved with raising unit in situ Compatibility issues with other equipment or furniture i.e. hoists, additional pressure relieving mattresses raising the height of the bed base Users should be aware that drawers in Divan bases will not be able to be used as they may de-stabilise the bed Using chair/ bed raising units To sit down:- Approach the chair/bed then turn around until the chair/bed is behind you Move backwards until the back of your knees touch the edge of the chair/bed Bend from your hips and knees and gently lower yourself until you are sitting on the chair/bed To stand up:- Ensure both feet are positioned slightly apart and flat on the floor If you are able, shuffle forward to sit near the edge of the chair/bed Lean forward and look straight ahead Stand up straightening your hips and knees as you rise Stand up straight and get your balance before stepping forward o Users should be discouraged from throwing themselves onto the chair or bed Maintenance Users should be aware that raising units must be checked regularly to ensure brackets remain tightly fastened and stability is maintained Units can be wiped with hot soapy water if required Bed raisers should be fitted by 2 people Page 25 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

27 BED RAIL / STICK / LEVER DESCRIPTION Metal rails, which slot between the bed base and the mattress to aid user to transfer in and out of bed The rails are held in place by the person s weight but can be secured with straps if required There should always be a central bar on the easy leaver to avoid the risk of entrapment Easy leaver and bedrail with straps should be used with slatted beds, bed stick unsuitable for this use Bariatric versions available for users out with the above swl Easy Leaver /rail - swl 17stones Bed Stick with two loops -swl 24st Bedrail with straps swl 17st Check Safe Weight Limits for usage as these can change Adjustments There are no adjustments in the easy leaver or bedrail The bed stick can be adjusted to fit single through to king size beds by removing e-clips and adjusting length of rail Loop on one side can be fitted pointing downwards to allow freedom of movement for other bed user who doesn t require it Considerations prior to issue Ensure bed is suitable to fit an easy leaver to is bed a divan base or slatted base? Establish if straps are required. The user must have some degree of upper body strength and mobility Have sufficient sitting balance Access to bedside table should not be impeded Access to under bed drawers should be considered * For additional information on the use of bedrails and cot sides please refer to the National Association of Equipment Providers Clinical Special Interest Group - Guidance on the Use of Bed Rails June 2011[ When should this equipment be used? To assist the user to manoeuvre in bed can be used to assist turning and also to assist the less mobile user to sit up in bed The easy leaver/ bed rail/ bed stick cannot generally be felt through the mattress and no adaptations are required to the bed The use of an easy leaver or bed rail will not affect a partner sharing the bed Contra Indications for use These are only transfer aids and should not be used to prevent someone falling out of bed. If this is the issue then Cot side rails should be considered if this is appropriate The easy leaver/ bed rail cannot be used to assist transfers from commode or wheelchair as it could be dislodged The easy leaver/bed rail only offers limited support when transferring from sitting on the edge of the bed to standing if it is not strapped on Not suitable for profiling and adjustamatic beds or use with pillow lifters or mattress raisers Unsuitable if the bed has 2 mattresses [i.e. pressure mattress which raise the level of the surface of the bed Fitting Risk of entrapment should be considered and the position of the rail should allow a gap of less than 60 mm or more than 250 mm at the top of the bed Lift or remove the mattress from the bed and place the rail against the inside of the bed base or frame. The handle should be placed at bottom edge of pillow where the user can easily grasp it from a lying position. Fix straps if required Replace the mattress and ensure the rail is sitting securely. Observe user demonstrate safe use of equipment Bed rail is placed under the mattress and tight against it to prevent the risk of entrapment Checks Prior to use Ensure easy leaver/ bed rail/ bed stick is positioned correctly just by pillow Demonstrate safe use of rail and observe user transferring using the rail The force required to dislodge any type of bed rail is dependent on the size, type and weight of mattress How to use the bed rail To get into bed:- Approach the bed, then turn around until the bed is behind you, standing as close to the bed rail as possible Move backwards until the backs of your knees touch the side of the bed Grip the bed rail with hand nearest to it Bend from the hip/knees and gently lower yourself, until you are sitting firmly on the bed Lean back towards the pillows and raise your legs on to bed. To get out of bed:- While lying in bed, reach across the body, with the arm furthest from the rail, and grab bed rail. (This can also assist turning in bed) Pull body towards the side of bed, while swinging legs over to the edge of the bed While lowering your legs to the floor, push up on the bed rail till sitting in an upright position. Ensure both your feet are positioned slightly apart and flat on the floor. Hold the bed rail, with the hand nearest to it, and push up slowly, straightening your hips/knees as you get up. Stand up straight, let go of the bed rail and get your balance before walking away. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Page 26 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

28 MATTRESS ELEVATORS / PILLOW LIFTS Information should be amended if different products are used in localities Dream Master mattress elevator [with knee break and side rails fitted ] Pillow Lifter DESCRIPTION The Mattress elevator is an electrically powered sit up device placed under the head end of a mattress to raise the mattress to form a backrest to assist user to sit up in bed. Elevator can aid independence and assist with safer manual handling techniques. It is width adjustable for use on single, three-quarter, double or king sized beds up to [1524mm or 60ins wide] Some models can have a knee break supplied to stop users from sliding down the bed when lying in slightly raised position. Some types have Side rails can be fitted on one or both sides as required. The Pillow lifter only lifts the pillow rather than the whole mattress WEIGHT RESTRICTIONS: 1) Mattress Elevator - 254Kg / 40 st 2) Pillow Lifter - 254kg / 40 stones. Check safe weight limits for usage as these can change Alternatives Consider a back rest where the person only needs a static raised pillow position and can control the position of the pillows themselves [pillows can slide around while in use] Consider a rail attached to the bed/frame/ mattress where appropriate, to assist the lying to sitting transfer NB: do not fit floor fixed rails beside beds as these can lead to risk of entrapment of head or limbs if the bed moves away from the rail When should this equipment be issued? The Service user s functional ability is not sufficient to sit up from lying without assistance and where no other simpler equipment will meet this need The service user has sufficient balance and trunk control to use the equipment safely, if they are using it independently The provision of a mattress raiser/pillow lifter would lessen the amount of disturbance and/or strain experienced by the carer, where no other equipment will eliminate this risk Considerations/ Contra-indications The mattress construction is suitable (i.e. without a rigid internal structure) and an electric socket is available where trailing leads will not create a tripping hazard It is advisable to use a hinged mattress to maximise the profile and to avoid damage to a standard mattress Many of these units do not angle under the knees to form a knee-break, unlike variable posture beds, and therefore, as users sit with their legs extended, they may slide down the bed. This movement may increase the risk of developing pressure ulcers If the person is tall the useful length of the bed left may be insufficient The service user should be willing to have a foot-board fitted to their bed, if this is required The service user and/or carer have the ability to manage the controls, consideration being given to hand dominance If providing a double unit, consideration should be given to the partner regarding possible inconvenience The pillow lifter can be used to avoid lifting the whole mattress when another person is sleeping The noise of the unit in operation may disturb others Pillows may need tapes to prevent slipping Stabilising straps may obstruct drawers on divan beds. Care must be taken when used in conjunction with other bed aids Bed levers/ sticks cannot be use with the mattress elevator in place Consideration should be given as to whether a profiling bed might be more appropriate with its ability to also raise and lower the height Body parts should be kept away from the moving parts of the elevator/lifter to avoid entrapment The moving parts could be dangerous to young children if not adequately supervised NB: Mattress elevators should not be issued where a static position is required that can be achieved with a standard back rest. Fitting Mattress Elevator [should be fitted by Store delivery staff] The Dream Master mattress elevator is placed on the bed and adjusted to the width of the mattress by sliding the base bars in and out. It secured to the bed and mattress with two straps, the first being a figure of eight strap at the foot of the bed and the second secures the mattress to the bed by means of a locking buckle on the frame. Fitting the Pillow Lifter Place the lifter on the bed with the mesh frame uppermost 2 from the top of the bed Secure the frame to the bed by passing the 2 green webbing straps under the bed and securing in the buckle on the base frame, then pull to tighten. Avoid tangling the actuator cable in the webbing straps Both Fitting and user instructions should be left with the equipment How to use the mattress elevator/ pillow lifter Handset should be placed near the user for independent use. It can be hung on the bed frame when not in use. Handset controls are up and down only Elevator can be tilted to between 5 and 85 degrees for comfort, pillow lifter from 9-72 degrees Maintenance: Equipment should be cleaned in accordance with manufacturer recommendations. Page 27 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

29 PROFILING BEDS DESCRIPTION Profiling beds are electrically adjustable to enable the user's position to be changed without strain for anyone involved. The most common profiling beds have a three or four part bed base. Either type will allow the backrest / pillow area of the bed to be raised, enabling the user to be more upright, while also lifting an area under the knees, to stop the user slipping down in the bed. The bed is also height adjustable and reduces strain for carers while moving and handling users as well as lowering to an appropriate height for users to transfer from sit to stand easily. They have inbuilt side rails. Weight restrictions Safe weight limit 140kg/ 22stones Check weight limits for usage as these can change Alternatives Bed raisers when variable height is not required for user or carers Mattress elevator/ pillow lifter when the only requirement is the need for assistance from lying to sitting Provide back rest / wedge where static pillow raise required Attach rails to the bed Provide free standing Lifting pole where no assistance is needed for the transfer in/out of bed Bariatric beds for those users in this category Criteria for provision Users should meet one or more of the criteria: Service user has difficulty when attempting to change position or is unable to change position independently - by changing position without manual involvement, the risk of injury to the carer is eliminated, and the independence and dignity of the user are maintained It may make it possible for someone to get out of bed unaided, if they can raise themselves into a sitting position first Service user has difficulty breathing or has circulatory problems - respiratory and circulatory difficulties can be eased Service user is unconscious or remains in bed throughout the day Service user has chronic back problems Service user requires a hoist or receives personal care whilst on the bed - it makes using a hoist easier. Most profiling beds also have a height adjustment, so the carer can work at a safe height when giving treatments, etc. Alternative options should have been considered and deemed to be inappropriate NB: Paediatric beds are provided under local agreements and arrangements Considerations prior to use A mattress should be ordered separately from the bed If a specialised pressure relieving mattress is required, compatibility should be considered Access to the property needs to be suitable to allow safe delivery/fitting An electric socket is available where trailing leads will not create a tripping hazard The service user and/or carer has the ability to manage the controls Adequate space is available to accommodate the bed Beds should usually be kept at the lowest possible height except when direct care is being given Bedrails should only be issued to reduce the risk of the service user accidentally slipping, sliding, falling or rolling out of a bed. Issues of inappropriate restraint should be avoided Consideration should be given to ensure the carer can manoeuvre around the bed when direct care is being given Storage of the users own bed should be considered to avoid inconvenience for the user, carers or others living in the house Manufacturer s weight limit guidance should be observed Specific needs for children should be considered as they are of lower weight and size and also have designated guidelines related to bed rails/ cot sides etc If a bed is to be used in the same room as a gas fire, is there a local policy related to this with advice about carbonmonoxide emissions and relevant disclaimers Reference: 1. National Association Equipment Providers Guidance On The Provision Of Beds And Bedrails 2. Health and Safety Executive Information and on-line training on provision of bedrails Installation of beds All beds are delivered and fitted by Store personnel Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Beds will be maintained by the Store Services on a yearly basis under LOLER regulations Page 28 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

30 PRESSURE RELIEVING MATTRESSES Pressure relieving mattresses are used in the prevention and/or treatment of pressure issues in service users. They can be static or dynamic in nature. They must be used in conjunction with other approaches to pressure care including repositioning, good hygiene, appropriate moving and handling techniques or medical/surgical intervention. The provision of dynamic pressure mattresses can only be carried out by Nursing staff, however static mattresses can be provided by staff who have the required skills to assess for and prescribe this equipment. All non-nursing staff have a role in the prevention of pressure issues. Only nursing staff have responsibility for active treatment of pressure issues. Further information related to selection of appropriate pressure relieving equipment can be found in Appendix 7 at the end of this document. NB: Specific needs for children should be considered as they are of lower weight and size and also have designated guidelines related to mattresses/ pressure mattresses etc Page 29 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

31 BED / SIDE RAILS DESCRIPTION Linked beneath a single bed mattress for stability and security the two adjustable sides will operate independently to raise or lower. They are designed to reduce the risk of a service user accidentally slipping, sliding, falling or rolling out... When not required the sides slide to the base of the bed. The strong framework is lightweight steel finished chrome. Bedrails used for this purpose are not a form of restraint. Bedrails will not prevent a patient leaving their bed and falling elsewhere, and should not be used for this purpose. Weight None specified, but bedrails are not intended as a moving and handling aid and should restrictions not be used as such. When should this equipment be issued? Service user is at risk of accidentally slipping, sliding, falling or rolling out of a bed. Considerations Side rails can pose a risk of serious injury, for example if part of the body gets trapped between them. Thus it is essential that care is taken when selecting, positioning and adjusting the rails and also when choosing or changing the type of mattress to be used in a bed with rails so as not to put the user at risk. The need for mattress in-fills may be considered to avoid gaps. There may be a risk of entrapment between the bed and rail where drop down rails are used Bumpers should be used for service users who are assessed as requiring bedrails, but who are at risk of striking their limbs or of entrapment Where Overlay pressure mattresses are used it must be insured that the combined height of the standard mattress plus the overlay does not render the bed rail too low as to be ineffective against the user falling out of the bed. Children may need rails with smaller gaps between the rails to ensure their safety. Decisions about bedrails need to be frequently reviewed and changed Guidance is available from the Health and Safety Executive [HSE] on the safe use of bed rails. * For additional information on the use of bedrails and cot sides please refer to the National Association Equipment Providers Clinical Special Interest Group - Guidance on the Use of Bed Rails June 2011 or visit Contra-indications Bedrails should not be issued if the service user is sufficiently agile and/or sufficiently confused, to climb over them If the service user lacks capacity, staff have a duty of care and must decide if rails are in the user s best interest A user who attempts to climb over the rails may fall from an even greater height Installation Bed rails are fitted by store personnel The position of the rail should allow a gap between the top end of the bedrail and the head of the bed of less than 60mm or more than 250mm The gap between the bottom end of the bedrail and the foot of the bed should be more than 250mm Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Page 30 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

32 SLIDING SHEETS - Different types and sizes available - Can come in 2 separate sheets or 1 tubular sheet DESCRIPTION The sliding sheet allows safe and comfortable transfers and assists positioning tasks. It removes the need to lift by assisting to turn a service user whilst lying or sitting in bed, rotating into and from supine position and moving users up the bed. They can also be used to move a service user from a difficult situation or awkward corners. Constructed from lightweight and durable doubled low friction fabric, the sheets allow glide between two surfaces, reducing skin friction for the user and making transfers easier for the carer. Weight restrictions None specified but bariatric sizes apply for those service users in this category. Alternatives Bariatric version for heavier / wider people or for use on double beds in some circumstances One way glides for use when repositioning people when sitting in a chair or bed. The sheet slides backwards into a secure sitting position. Slip-resistant material in the bottom panel locks the sheet into place, avoiding the risk of slipping off the seat or bed and reducing the effects of friction on the skin - A risk assessment should be carried out to ensure the chair is suitable for this equipment if it is to be left in place under the user [should be for short periods only] - Most one way glides have latex in the fabric and allergies should be considered - Issues of friction on the skin need consideration When should this equipment be issued? The person requires assistance to move in bed or in a chair The person is at risk of frequent falls and therefore may need to be moved from an awkward corner. Considerations prior to use Carers have undertaken training and are competent in its use Ensure that 2 sheets are ordered if not the tubular type The slip sheet is the correct size, clean and free from any wear and tear Ensure the entire length of the person s body particularly the pressure points are supported by a slip sheet before moving the person Contra-indications It may be dangerous to leave the slip sheet under the person if they tend to slide down bed / chair Do not leave lying on the floor when not in use as they are a slide hazard for others Using the slip sheet Manufacturer s guidance for use should be observed Generally 2 carers are required to use this equipment effectively The slip sheet is stored safely when not in use Maintenance The manufacturer s instructions for laundering should be followed Page 31 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

33 TRANSFER TURNTABLE DESCRIPTION A strong and lightweight turntable providing smooth and easy rotation for transfers to and from a bed, chair, car, etc. It features a 360 turning circle and a gripped upper surface for added user security. Users can also use the product to assist independent transfers when making seated to seated transfers where feet tend to stick to the floor. WEIGHT RESTRICTIONS Must be used with the assistance of a carer when the user intends to stand on the equipment. Safe Weight Limit: 19st/125kg Check Safe Weight Limits for usage as these can change. Dimensions Diameter: 405mm (16in), Weight: 1kg (2lbs) Alternatives Patient turner, Active Stand Aid, Passive Hoist When should the transfer turntable be used? Only for use with service users who can stand well or long enough to cope standing up with minimal support by carers for the period of the transfer. Carers should not be holding the user in the standing position Allows service users with moderate upper and lower limb strength as well as adequate standing balance to participate in functional transfers To assist in maintaining strength in the legs for as long a possible by supporting users to stand up and transfer safely To avoid the use of a patient turner, stand aid or passive lifting hoist To assist independent transfers when making seated to seated transfers where feet tend to stick to the floor Considerations prior to use Formal Carers should have attended statutory training and/or regular refresher training on general Moving and Handling [M&H]procedures/policy and be deemed competent to use this equipment Informal carers should receive demonstration and instruction on the use of this equipment from assessors and providers of this equipment. Some may require further M&H training [see local arrangements for this] The instructions for the safe use of this product are very specific and informal carers require to be competent and confident of adhering to them before provision is considered Has the risk assessment been undertaken to establish if the service user can stand safely using this equipment? Has risk assessment identified how many carers are required to use the equipment depending on the service user s level of mobility and reliability in attaining and maintaining a standing position? N.B. Service user s mobility may fluctuate throughout the day or may progressively deteriorate. Users need to have good standing balance Users need to be able to comply with instruction for safe use of the equipment Service User/patient specific moving and handling profile should be recorded. Contra-indications Unsuitable for those with inadequate standing balance or who require assistance to maintain a standing position Unsuitable for users who cannot comply with instructions for safe use of the equipment Unsuitable for use with those with unpredictable behaviour As the carer has to fit in the angle between 2 chairs to support the user safely, there is limited space for larger users or carers Page 32 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

34 Using the transfer turntable It is the responsibility of anyone using the turntable to carry out a visual inspection for any defects prior to use. i.e.:- Check the base of the turntable is turning freely Do not leave the service user un-attended while standing on / using the turntable. To use Carer places the chair the user is to be transferred into next to the chair they are sitting on. Usually at a 90 degree angle. Place the turntable directly in front of the seated user and the second chair User places their feet on the turntable o N.B. It is important that that turntable is not too far in front of the chair as the user will find it difficult to rise if their knees are not flexed to at least 90 degrees To move to the user s left:- Carer stands at right angles to the front of the first chair with their back to the front of the second chair. Once the user has achieved a standing position with minimal assistance the carer places their right hand on the middle of the back of the user and their left hand on their front waist. The carer s right hip should be touching the left hip of the user. The users arm should be held against their stomach to maintain a centred standing position not around the carers back or holding onto them in anyway. Carers should not hold the user at arms length as this will not assist the user to feel safe when the turntable is in motion. Carer then moves in a clockwise direction supporting the user until the backs of the user s legs are facing the front of the second chair. User sits down by making sure the back of their legs are touching the front of the seat, then reaching back to hold the arms of the chair initially with one hand then with the other to guide them. Carer removes the equipment from the front of the user. To move to the user s right:- Carer stands at right angles to the front of the first chair with their back to the front of the second chair Once the user has achieved a standing position with minimal assistance the carer places their left hand on the middle of the back of the user and their right hand on their front waist. The carer s left hip should be touching the right hip of the user. The users arm should be held against their stomach to maintain a centred position not around the carers back or holding onto them in anyway Carers should not hold the user at arms length as this will not assist the user to feel safe when the turntable is in motion Carer then moves in an anti-clockwise direction supporting the user until the backs of the user s legs are facing the front of the second chair User sits down by making sure the back of their legs are touching the front of the seat, then reaching back to hold the arms of the chair initially with one hand then with the other to guide them. Carer removes the equipment from the front of the user. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations Will be serviced and maintained by the Store services under LOLER regulations Page 33 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

35 PATIENT TURNER WEIGHT RESTRICTIONS DESCRIPTION The patient turner assists carers to facilitate standing and seat-to-seat transfers, whilst minimising the risk of injury to themselves and the patient as well as ensuring good working postures for carers and therapists. Height adjustable and angled knee pad facilitates normal hip and knee movement. Height adjustable hand bar to suit a range of clients. Thigh pad gives the client a secure and supportive contact point for increased stability and comfort during transfers. Patient turner rotates through 360 for repositioning in confined spaces. Non-slip footprints provide secure foot placement Carer controlled foot brake prevents rotation and over-balancing during sit-to-stand transfer. Two rear castors provide easy transport Front mounted sprung castor assists the carer in positioning the turner once the client s feet are in position. Safe Weight Limit: 190Kgs (30 Stones) Check Safe Weight Limits for usage as these can change. Dimensions Bottom Handle Min Height: 815mm Bottom Handle Max Height: 1175mm Top Handle Min Height: 920mm Top Handle Max Height: 1315mm Centre Of Knee Pad Min Height: 235mm Centre Of Knee Pad Max eight: 510mm Alternatives Floor based turntable with no support column Active Stand aid Passive hoist When should the patient turner be used? For use with service users who cannot stand well or long enough to cope with a basic floor based turntable Allows service users with moderate upper and lower limb strength to participate in functional transfers To assist in maintaining strength in the legs for as long a possible by supporting users to stand up and transfer safely To avoid the use of a stand aid or passive lifting hoist Considerations prior to use Formal Carers should have attended statutory training and/or regular refresher training on general Moving and Handling [M&H]procedures/policy and be deemed competent to use this equipment Informal carers should receive demonstration and instruction on the use of this equipment from assessors and providers of this equipment. Some may require further M&H training [see local arrangements for this] Has the risk assessment been undertaken to establish if the service user can stand safely using this equipment? Has risk assessment identified how many carers are required to use the equipment depending on the service user s level of mobility and reliability in attaining and maintaining a standing position? N.B. Service user s mobility may fluctuate throughout the day or may progressively deteriorate. Users need to have good standing balance Users must be able to hold onto the handle to remain centred while standing up Users need to be able to comply with instruction for safe use of the equipment Is there space to store the equipment when not in use? Service User/patient specific moving and handling profile should be recorded. Contra-indications Unsuitable for those with inadequate standing balance Unsuitable for users who cannot comply with instructions for safe use of the equipment Using the patient turner It is the responsibility of anyone using the patient turner to carry out a visual inspection for any defects prior to use. i.e.:- Check the base of the turntable is turning freely Check that knee and/or thigh pads are at the correct height for the service user Check that the knee pads are at the correct height for the user[ edges not digging into/under the knee cap] Check that the support column is the correct height for the user to reach easily and support them while standing in an upright position supporting most of their own weight. User should not be leaning back [column to high] or too far forward [column too low] Do not leave the service user un-attended while standing on / using the patient turner. To use Begin by positioning the new seat (chair, wheelchair, toilet or bed) in the required position. Slide Turner in under the user s feet. Adjust the height of the lower leg support so that its upper edge lines up just under the knee of the user. Adjust the height of the handle to a position that is comfortable for both user and carer. Grip the handle with both hands and places one foot on the pedal. Grip the handle with both hands. Encourage the user to stand up while, at the same time, counterbalancing the user s weight using a foot and hands (use your bodyweight by leaning backwards). Twist Turner so that the user is transferred to the front of the new seat. Step on the pedal, brace your weight and ask the user to sit down. Maintain eye contact with the user during the entire transfer process. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Will be serviced and maintained by the Store Services under LOLER regulations Page 34 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

36 STEDY AND CRICKET PATIENT HANDLERS Description The Stedy and the Cricket assist people who are weight bearing for short periods but non-walking, without the use of a passive lifting hoist and sling. They are attendant propelled for moving around and the integral seats support the user when being transported until they can stand to transfer back onto a seat/bed/toilet. Wheels are braked while transfers take place. Stedy WEIGHT RESTRICTIONS Alternatives Can be used with only one carer if the user can stand unassisted otherwise 2 carers are usually required. Safe Weight Limit: Stedy / Cricket - 120kg/19stones Check Safe Weight Limits for usage as these can change. Patient turner [with support pillar]for those who need to use a wheel chair for transport around the home Stand aid for those requiring sling support while standing Passive lifting hoist for those with no weight bearing capability Considerations prior to use To enable users who cannot walk safely to retain the ability to stand up for short periods. To assist in maintaining strength in the legs for as long a possible by assisting users to stand up safely To avoid the use of a Stand aid /passive lifting hoist To reduce the number of transfers needed to achieve i.e. going to the toilet Users need to have good sitting balance The Stedy legs require 5 of clearance beneath chair and beds for access. The Cricket requires 3 clearance. If used for toilet transfers the legs of the basic Stedy and Cricket models can fit around the toilet pedestal in standard toilets [the larger Sara Stedy has legs that manually abduct for greater access around toilets, chairs etc. This is a nonstock order] Users need to be able to comply with instruction for safe transfers onto the equipment Are there any obstacles for the smooth running of the wheels when the equipment is in transit? [Door thresholds/ steps/ too much furniture] The foot base which user stand onto raises the floor level by about 2-3 and can result in the hips being below the level of the knees while seated in their chair. This can make transferring from sitting to standing more difficult for those with weak leg muscles. Ensure wheels are running freely and brakes are in working order before use Ensure that the fabric seat on the cricket is free from any wear and tear before use. Is there space to accommodate/ store the equipment when not in use? Contra-indications Unsuitable for those with inadequate sitting balance Unsuitable for users who cannot comply with instructions for safe transfers onto the equipment Clients who are exceptionally tall or have disproportionately long legs may find the leg room inadequate. The Stedy s seat has a 35º slope which causes users knees to side downwards into the knee cushion. This can be uncomfortable for those with painful knees and especially if they are on the seat for more than a short period. The slope can be difficult to cope with if legs are very weak The Environment is too limited/cluttered for safe use of the equipment Adjusting the height The Stedy has no adjustability The Cricket has height adjustable front bars and knee support and should be adjusted to allow the user to stand up as straight as possible without stooping or leaning backwards. The knee support should sit in front of the knees allowing the knee to press into the cushioning if required, and avoiding the edge of the cushion digging into the lower edge of the patella. Using the Stedy or Cricket Push the Stedy/Cricket up to the front of the chair/bed/ toilet until the foot base is under the user s feet as they would normally be placed to rise from a chair Apply the brakes Fold back the seat to allow the user to stand into the equipment The user should rise from the chair using the chair arms[if available] to push up until they have achieved standing balance Users should then transfer hands from the chair arm[if available] to the front support rail of the equipment Carers should then put the seat in place behind the user and ask the user to sit down on the seat Brakes are disengaged prior to rolling the equipment away from the chair/bed/toilet To alight from the Stedy/Cricket push the equipment to the front of the chair/bed/toilet Apply the brakes Ask the user to stand up using the front bar of the equipment for support Fold back the seat Ask the user to sit down on the chair/bed/toilet as they would normally do. Fold down the seat into its normal seated position, disengage the brakes and roll the equipment away. Maintenance Cricket Equipment should be cleaned in accordance with manufacturer recommendations. Page 35 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

37 TRANSFER BOARDS Available types Straight Wooden board [ SWL 190kg/ 30st] Wood or plastic Curved board[swl 190kg/ 30st] Plastic - For use in wet areas [SWL - 285kg/ 45st] NB Check Safe Weight Limits for usage as these can change. Alternative provisions Handling belt is also available if assistance is required to complete the transfer. Hoist may be required if the user is unable to transfer unaided. When should this equipment be used? DESCRIPTION Low friction board which enables the user (with or without assistance) to slide transfer between surfaces of approx equal height. The transfer board is positioned equally on the two transfer surfaces, ensuring that approx 1/3 rd of the total length of the board is on each surface Suitable for car, bed, chair and toilet transfers. User is non weight-bearing or weight bearing is unpredictable and/or carers are at risk while completing essential transfers. Height of both transfer surfaces should be within 1-2 of each other, depending on user s upper body strength/stability. The gap between both transfer surfaces should be no more than 1/3rd of the total length of the transfer board. The gap between both transfer surfaces can be minimised in order to maximise safety and reduce the effort required to transfer. NB space taken up by the person transferring. Adequate space is available to facilitate side transfer. Considerations during assessment User needs to have good trunk control, sitting balance and upper limb strength. Cognitive ability of user. Skin integrity this transfer can increase the risk of skin breakdown due to friction and shearing of fragile skin. Where transfers are from shower/bath to chair/wheelchair a wet transfer board should be used. These are made of very low friction polypropylene or some have in-built sliding sheets. [DO NOT USE UNATTACHED SLIDING SHEETS] The height differential between surfaces may vary during transfer depending on firmness of the transfer surfaces. Surface that user will transfer from/to must ideally have no side/arm obstructions i.e. be a commode with a removable arm or chair/ wheelchair with removable side. Where 1 arm remains a curved board should be used and the angle between the surfaces is as acute as possible or overlapped. If assistance is required, the carer must maintain good posture throughout the transfer. Moving and Handling training can be offered to the carer. Compatibility issues Measuring dimensions Optimum height between transfer surfaces is NIL. Maximum height between transfer surfaces should be restricted to 2, but will depend on the user s ability. Using transfer boards - Positioning the Board Make sure the transfer board is beside you for use. Position yourself beside the surface you wish to transfer on to, ensuring the gap is minimised between both surfaces. If possible remove any armrests and footplates closest to the surface you want to transfer onto. Position the feet on the floor and adjust foot position throughout the transfer. Place approx 1/3 rd of the transfer board onto the surface sat upon, ensuring the edge is securely tucked under your bottom. Position the remainder of the board across the gap ensuring that approx 1/3 rd of the board rests on the surface you want to transfer onto. The Transfer Using the hand closest to the direction of travel, place your hand on the available board beside you in a comfortable position. The other hand should be placed on the surface being transferred from. By pushing body weight through your hands, you should gently lift yourself and slide across the board, repositioning your feet as they travel. Repeat until you are sitting securely on the new surface. Removing the Board Remove the section of the transfer board that is tucked under your bottom. Place the board on the floor or in a suitable position, ready for re-use. Maintenance To clean the board it is recommend that hot water and a soapy solution or non-abrasive cleaner is used. Page 36 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

38 STAND AID DESCRIPTION The Stand aid is an electrically powered active lifter for those who have some weight bearing capability. Slings are used to assist the lifting from sitting to standing but the user should be weight bearing once fully in the standing position. 2 slings can be used:- Standing sling For use to assist the person to stand up Transport sling Has leg supports which only provide support if the person s legs give way while standing and will prevent the person falling to the ground The stand aid should not be used to transport people from one room to another or to leave a person in for any length of time Standing sling Transport sling WEIGHT RESTRICTIONS Safe Weight Limit: 140kg/22 stones [Stand aids with higher SWL are available as non-stock items] Check Safe Weight Limits for usage as these can change. Alternatives Stedy or Cricket patient handlers [See previous section for details of their use] Portable/folding standing aids for transporting outside the home [non-stock orders] When should the Stand aid be used? To enable users who cannot walk safely to retain the ability to stand up for short periods To assist in maintaining strength in the legs for as long a possible by supporting users to stand up safely To avoid the use of a passive lifting hoist Considerations prior to use Formal Carers should have attended statutory training and/or regular refresher training on general Moving and Handling [M&H]procedures/policy and be deemed competent to use this equipment Informal carers should receive demonstration and instruction on the use of this equipment from assessors and providers of this equipment. Some may require further M&H training [see local arrangements for this] Has the risk assessment been undertaken to establish how many carers are required to operate the stand aid safely? [Staff require to adhere to the recommendations within their own Partnership regarding numbers of carers required to use equipment] Users need to have good sitting balance Users must be able to hold onto the frame to remain centred while being lifted Users need to be able to comply with instruction for safe use of the equipment Users must be able to lean back onto the sling while rising to standing to avoid a Drag lift resulting The Stand aid legs require 5 of clearance beneath chairs and beds for access. Are there any obstacles for the smooth running of the wheels when the equipment is in use? [thick carpets/ cluttered environment] Is there space to store the equipment when not in use? Service User/patient specific moving and handling profile should be recorded. Contra-indications Unsuitable for those with inadequate sitting/ standing balance Unsuitable for users who cannot comply with instructions for safe use of the equipment The Environment is too cluttered for safe use of the equipment Using the Stand aid Ensure that the sling used is the correct one for the Stand aid. The Oxford Stand aid uses specific loop slings [See above] It is the responsibility of anyone using the Stand aid, to carry out a visual inspection for any defects prior to use. i.e.:- 1. Check the Stand aid and slings are safe and fit to use and there are no signs of wear and tear 2. That it has been serviced within the legally required period before using it [serviced 6 monthly under LOLER regulations] 3. Ensure wheels are running freely and brakes are in working order before use 4. Check the battery is fully charged and operational Apply the slings to the service user and then to the Stand aid as per training instructions Do not leave the service user in the stand aid for longer than necessary to lift and re-position the user in the bed/chair etc Do not leave the service user un-attended while standing in the raised Stand aid Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Will be serviced and maintained by the Store Services under LOLER regulations Page 37 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

39 MOBILE HOISTS DESCRIPTION Manual or electrically powered lifting equipment which enables the carer to lift the service user safely in a lying, semi reclined or sitting position. Slings are used and many designs are available depending on the user s needs and tasks being undertaken Hoists should not be used when service users have reliable ability to weight bear [this can vary depending on the time of day for some service users] Weight restrictions Safe Weight Limits Various depending on the specific hoist Stores often have several stock hoists of different safe weight limits Check Safe Weight Limits for usage as these can change. Alternatives Manual and electric versions Bariatric versions Stand aid for people with some residual weight bearing capability Ceiling track hoist When should this equipment be issued? The service user has been assessed as non-weight bearing and/or carers are at risk whilst completing essential transfers If the hoist is going to be used frequently by care staff or family then consideration should be given to the issue of an electric hoist. The service user and/or carer s needs indicate that a ceiling track hoist is not required, or the mobile hoist is a temporary provision pending installation of a ceiling track hoist. Service User/patient specific moving and handling profile should be recorded. Considerations Prior to use Formal Carers should have attended statutory training and/or regular refresher training on general Moving and Handling [M&H]procedures/policy and be deemed competent to use this equipment Informal carers should receive demonstration and instruction on the use of this equipment from assessors and providers of this equipment. Some may require further M&H training [see local arrangements for this] An assessment has been carried out on an individual basis to determine the number of carers required. [Staff require to adhere to the recommendations within their own Partnership regarding numbers of carers required to use equipment] The hoist is suitable for the environment, access for transfers, space to manoeuvre, height/space under bed/ chair and there is a suitable storage area Type of activity and frequency of use has been considered If the service user/patient s clinical condition presents further issues e.g. the pumping action may trigger a seizure, spasm or cause pain because of a pre-existing medical condition then, specification of an electric hoist should be considered to allow a smoother rise and lowering action Weight limit of the hoist should be considered in relation to the safe working load The user must be familiar with the Manufacturer s operating instructions and competent in the use of the hoist The hoist must have sufficient boom height to allow the service user to clear the surface they are sitting/lying on when raised in the sling.- Where clearance is marginal a sliding sheet can be used to prevent friction between the surface and the sling and to aid moving/turning the patient i.e. to get from bed to a chair along side The hoist must only be used for transfer, not transport, e.g. only from bed to chair within the same room Ensure sling is applied correctly[see information in next section] How to use the hoist Ensure that the sling used is the correct one for the hoist. Hoists use specific slings with loop and/ or clip attachments and must be compatible with one another. It is the responsibility of anyone using the hoist, to carry out a visual inspection for any defects prior to use. i.e. 1. Check the hoist and slings are safe and fit to use and there are no signs of wear and tear 2. That it has been serviced within the legally required period before using it [serviced 6 monthly under LOLER regulations] 3. Ensure wheels are running freely and brakes are in working order before use 4. Check the battery is fully charged and operational Apply the slings to the service user and then to the hoist as per training instructions Do not leave the service user in the hoist for longer than necessary to lift and re-position the user in the bed/chair etc Do not leave the service user un-attended while raised in the hoist Contra-indications The service user has reliable weight bearing capacity The service user/patient s clinical condition presents further issues e.g. the pumping action may trigger a seizure, spasm or cause pain because of a pre-existing medical condition, which cannot be resolved by provision of an electrically powered hoist The service user has cognitive issues or confusion which renders use of the equipment unsafe. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Will be serviced and maintained by the Store services under LOLER regulations Page 38 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

40 SLINGS basic shapes available Access/Toileting Sling: Suits only 25% of users as they need to have good sitting balance and upper body control Quickfit/Universal Sling: Suits up to 85% of users and provides upper body support Full Back Sling: Suits 85-90% of users and provides upper body support and head support Longseat sling [hammock type] support: Suits frailer service users/ amputees/ spinal injuries. Used with extender bars on the hoist to widen the attachment spacing] Description A sling is an item of moving and handling equipment that is used with a mechanical hoist in order to facilitate the transfer of a patient. A sling comprises a specially designed and constructed piece of fabric that is placed under and around a service user before being attached to the cradle/spreader bar of a lift to raise, transfer and lower the person. When selected and used correctly, a sling and hoist will achieve a safer transfer, reducing the risks associated with manual handling. Alternatives Different fabrics and designs available: - some are only available as non-stock orders Polyester Netting mainly used for bathing Padded for service users who have skin integrity issues, pain or are underweight and frail. Fleece edges - for service users who have skin integrity issues, pain or are underweight and frail. Longseats with commode aperture Reinforced to improve postural support i.e. for head or spine With loop attachments [essential that these are compatible with the hoist being used] With clip attachments [essential that these are compatible with the hoist being used] Integral sliding sheet to aid application Specialised slings that are non-stock orders Glove type slings that provide greater comfort and are easier to apply for those service users with complex needs When should this equipment be issued? The service user has been assessed as requiring a hoist for transfers. Considerations A risk assessment must be carried out to ensure hoist/sling compatibility. The sling must meet the service user s needs with reference to model, size, fabric and design Careful consideration is required regarding choice of sling, in particular service users with issues such as extensor spasm, seizures, low muscle tone, confusion, painful joints or amputation The user must be familiar with the manufacturer s guidance for both the sling and the hoist being used, and be competent in their use A visual inspection for any defects should always be carried out prior to use. The sling must be securely attached to the spreader bar before attempting to lift the service user The amount of time the service user remains suspended in the sling should be kept to a minimum Manufacturer s safe working load and laundry instructions must be observed The service user should be reassessed on a regular basis or when there is a notable change to their physical and/or mental status NB Sling sizes are not consistent across manufacturers. For further information please also refer to local arrangements for your Partnership. Quickfit Deluxe: Suits 90% of users and provides a more comfortable supportive lift particularly for those with skin integrity issues or who are heavier. Useful link: - The process of applying a sling to a service user is specific to the chosen sling. Osprey Healthcare provides online videos demonstrating the application of their slings which can be useful as a training tool for less experienced staff. It must be noted that there could be some differences in the process in slings from different suppliers. Web link - Page 39 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

41 WALKING EQUIPMENT Non-physiotherapy staff are recommended to attend full training on the assessment and provision of non-complex walking equipment prior to prescribing to service users. WALKING STICKS Selected when someone has good balance and just a small amount of support is needed. The person will normally be able to support most of their weight. Measuring for a walking stick The elbow should be bent to 15 degrees and the distance from the crease of the wrist to the floor at 15cm to the side of the heel. Service users should be standing as upright as possible. How to use a Walking Stick If using one stick for pain or weakness: Hold a walking stick in the opposite hand to the weak or painful leg Always move the stick forward first followed by the weak or painful leg, then the other leg If using a walking stick for balance: Hold the stick in the most comfortable hand Always move the stick forward first then the opposite leg Do not place the stick too far in-front or too far out to the side Do not carry the stick in the air as this is unsafe and service users may be at risk of falling Getting up from a chair: The stick should be near the arm of the chair and never left on the floor while not in use Lean forward, place hands on the arms of the chair and push up to stand. Some users can hold the stick in their hand while pushing up from the arm of the chair Take a firm hold of the stick - Pause before moving off Sitting down on a chair: When returning to the chair, the service users should turn until they feel the chair on the back of both legs. They should put the stick down close to them. Place their hands on the arms of the chair, bend forward and slowly lower themselves into the chair. [sitting down is a falls risk time for some service users.] Stairs: If stairs have a secure handrail, hold onto it for safety When a stair rail is used in addition to the stick the stick should be in the opposite hand to the rail regardless of which hand the stick is usually held in. - N.B. This could be an issue for users with no use of the other hand Where possible go up and down the stairs normally Service users should only attempt the stairs alone if they feel safe, otherwise they should ask someone to help them. If this is the case they should be assessed by a physiotherapist Upstairs: Step up with the good leg, then with the affected leg onto the same step The stick is the last to move up level with their feet Downstairs: First place the stick safely on the lower step keeping it away from the edge Step down with the affected leg Follow with the good leg onto the same step Service users should make sure they place the whole foot onto the step They should always take their time Advice for Assessors If a user needs assistance on stairs despite provision of a walking aid, an assessment by a physiotherapist should be sought. General safety with walking sticks! Regularly check walking stick for bends, elongated adjustment holes or loose handles Check the rubber ferrule on the bottom of the stick has not worn smooth or split [These can be replaced by contacting the local physiotherapy department.] Remove any loose mats and rugs to prevent tripping Make sure lighting is adequate around the house Wear flat supportive shoes that fit well Eyesight should be checked regularly o (if over 65, annual check ups are advised) Be aware of hazards including wet floors, uneven surfaces, wet leaves, and ice and carrying too many bags Page 40 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

42 Walking Frames and Wheeled Walking Frames Walking frames are used for the same reasons as sticks, but the service user needs greater support from the stability of the large base. Frames also remain standing without the support of the user. N.B. Wheeled walking frames allow for a more normal walking gait Do not use walking frames and wheeled walking frames outdoors it is unsafe Suitable alternative equipment is available only through Physiotherapy Departments How to measure for a Walking Frame As with sticks, service users should have enough elbow flexion to allow the frame to be moved forward comfortably. They should not be stooped but standing as upright as possible to use the frame The frame should not be so high that they struggle to lift it and move it forward o If it is too high it can cause service users to lean back and be at risk of a fall. How to use a walking frame / wheeled walking frame To walk Place both hands on the frame. Either lift or push(if wheeled) the frame one step ahead of you. Step the affected leg forward first. Follow with the other leg stepping up to or in front of the affected leg Do not walk too far into the frame or lift or push too far ahead of you When steady, lift or push the frame forward a short distance again and step forwards like before To Turn Only lift the frame round a little at a time, then step your feet round in line with the frame Repeat until turned Avoid moving your feet and frame at the same time Getting up from chairs Position the frame in front of the chair Place your hands on the arms of the chair Lean forward and push yourself up to stand Transfer your hands to the frame when steady Always pause for a moment before walking off Do not pull on the frame to stand up or sit down Sitting down into a chair When returning to the chair, turn around and keep using your frame until you feel the chair against the back of both legs Place your hands on the arms of the chair, bend forward and slowly lower yourself into the chair General safety with walking frames! Ensure the legs on the frame are not bent Ensure the joints on the frame are not loose Do not use the frame to go up or down stairs 2 walking frames should be issued for upstairs and downstairs use Where 1 step has to be negotiated, provision of a grab rail may be advised Check the rubber ferrules on the bottom of the frame are not worn smooth. These can be replaced by contacting your local physiotherapy department Remove any loose mats and rugs to prevent tripping Make sure lighting is adequate around the house Wear flat supportive shoes that fit well Eyesight should be checked regularly (if over 65, annual checkups are advised) For further information about the assessment of need for NON-COMPLEX walking equipment please refer to the Physiotherapy Walking Equipment Training Pack. Page 41 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

43 REFERENCE GROUP 1. Shona Millar: Professional Lead, Project Team, Equipu Partnership 2. Liz Watt: Senior Occupational Therapist Aberdeen City Council 3. Sue Fulton: Occupational Therapy Team leader, Perth & Kinross Council 4. Hannah Cairns: Specialist Occupational Therapy Advisor, Community Equipment Service, Edinburgh City Council 5. Averil Somerville: Senior Practitioner Occupational Therapist, Perth and Kinross Council 6. Catherine Rae: Senior Community Nurse NHS Grampian 7. Emma Szadurski: Specialist Occupational Therapy Advisor, Community Equipment Service, Edinburgh City Council 8. Allison Taylor: Team Manager - Occupational Therapy Service, Angus Council S:\OPPD\Services\Services\EQUIPU\SCOT GOVT - SNAEP\NAEP\NAEP - Training Manual - Extended Version 22 August 2012.doc Page 42 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

44 APPENDIX 1 Sample Power Point: Introductory Presentation 1. Partnership logo Joint Protocol Joint training on the assessment,prescription, fitting & demonstration of equipment 2. Joint Protocol Partnership logo COURSE OBJECTIVES - by the end of this course you will be able to explain the core reasons for the Protocol and joint working approaches be able to describe your role in relation to the assessment & provision of equipment within the Protocol Be aware of your responsibilities for adhering to the Partnership s criteria for provision have fitted and demonstrated the use of the Core Prescribed List equipment. 3. Joint Protocol Partnership logo Purpose: to establish a joint inter-agency agreement on the timescales for assessment and handling, and the delivery and management of the provision of equipment. Between:- TBC LA Health Others Page 43 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

45 4. Joint Protocol Partnership logo Main Aims Streamline the access to service delivery Improve the speed, efficiency and effectiveness of service delivery Maximise the use of resources 5. Principles of assessment Partnership logo The principal of MINIMAL INTERVENTION, MAXIMUM INDEPENDENCE shall underpin every assessment. Alternative methods of managing have been tried and found not to be successful. Preference alone must in no way influence the type of provision Taking account of the service user s and carer s views is an integral part of the assessment process. The assessor will only act on those recommendations which meet with the service user s and carer s approval. 6. General advice The attached information will be used as guidance for the practitioner, and will be supported by manufacturer guidelines [available on the CES website] and by ongoing training opportunities. In accordance with the Joint Protocol, the practitioner, where ever possible, will check the equipment within 24 hours of supply, to ensure that: Partnership logo The equipment has been fitted correctly, To demonstrate the correct use of the equipment Ensure that the customer tries the equipment in their presence, and is safe in its use The equipment meets the service users assessed needs If the equipment is found not to be suitable, the equipment must be dismantled/set aside, and uplift arranged via EQUIPU IT system. EQUIPU delivery staff shall issue the relevant Equipment Information Sheet to the customer with both fitting and using instructions. The practitioner should note in their case notes/case file that the equipment has been issued, fitted and demonstrated appropriately Assessors must be aware of the potential differences in the environment between home and hospital, if the assessment takes place in hospital Page 44 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

46 7. General Guidelines for use of Equipment Ensure equipment is in good condition and report any faults to the equipment service via Local arrangements Always ensure equipment is fitted properly according to manufacturer s instructions and that it will fit within the designated space. Ensure all clips and screws are securely in place. And rubber ferrules are in good condition Ensure that legs are set at the same height and are stable. Ensure equipment is kept clean and check wheels are running smoothly. Equipment should not be moved between one user and another- it must always be returned to the store to be cleaned and decontaminated It is advisable to check Safe Weight Limits for usage as these can change. This is particularly important when users are near the upper weight limit for the product. Also procurement processes can require that stock products may change If the equipment requires to be charged, never try to move it while connected to the charger. Ensure equipment is maintained in accordance with manufacturer s instructions. 8. Prescribed equipment list Partnership logo Toileting Raised toilet seat Toilet Frame - Free standing/ Floor fixed Combined toilet seat and frame - Free standing/ Floor fixed Commodes and Urinals Bathing/ Showering Bath board / Bath seat / Shower board/bath step Static shower stool / Static and mobile shower chairs/powered bath lifts and Swivel bathers Household and General Trolley/ Zimmer Caddy Perching stool with/without back and arms or combinations thereof. Grab rails Safety Guards Small Equipment for:- Food preparation, Eating and drinking, washing and dressing Page 45 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

47 9. Prescribed equipment list [cont] Partnership logo Beds Bed levers/ rails Mattress elevator Back rests Chairs Orthopaedic chairs Chair raising blocks Mobility Walking sticks, walking frames Standard Walking frames wheeled Moving and Handling Profiling beds/ standard mattresses Slip sheets Mobile hoists Slings Transfer Boards Monkey poles 10 Joint Protocol Partnership logo Equipment information and demonstration small groups 11 Joint Protocol Partnership logo Joint Training Summary & evaluation. Page 46 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

48 NAEP Training Pack Sample Programme APPENDIX 2 Joint Training Assessment/prescription,demonstration/fitting of core list equipment Course Programme: 9.15 am Welcome & Introductions Introduction Course Objectives, Programme Plan Session 1 The Joint Protocol - background Information General advice Principles of assessment Equipment to be demonstrated am Session 2 Equipment information & demonstration - Small group hands on sessions, question and discussions (trainers) Toileting equipment 1. RTS 2. Toilet frame 3. Combined toilet seat and frame Bathing Equipment 1. Bath/shower board 2. Bath seat 3. Shower stool am Coffee Break am Session 3 Bathing Equipment [cont] 4. Shower seats static/ mobile/complex 5. Swivel bather 6. Bath lift pm Lunch Household 1. Trolley/ Zimmer caddy 2. Perch stools 3. Grab rails 1.00 pm Chairs 1. Orthopaedic chairs 2. Chair raising blocks Bed accessories 1. Bed raising blocks 2. Bed levers/rails 3. Mattress elevators Walking equipment 1. Walking sticks 2. Walking frames 3. Wheeled walking frames 2.30pm Coffee break Page 47 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

49 2.30 pm Session 4 Moving and handling equipment 1. Profiling beds 2. Lifting Poles 3. Slip sheets 4. Turntables 5. One way glides 6. Mobile Hoists 7. Slings 8. Stand aids 9. Stedy 10. Cricket 11. Transfer boards 12. Patient Turner 4.15pm Summary Summary & Evaluation 4.30pm Course End Page 48 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

50 CORE LIST SAMPLE PRE-POST COURSE EVALUATION FORM APPENDIX 3 THANKS FOR TAKING THE TIME TO COMPLETE THIS FORM. THE INFORMATION COLLECTED WILL HELP US SUPPORT YOU AND YOUR COLLEAGUES IN FUTURE TRAINING NAME: LOCATION AND POST: CONTACT TEL.NO. DATE: 1. What would you describe as the main reasons for the Joint Protocol for equipment provision? 2. Look at the attached list of equipment on the Core List. Based on your knowledge and experience, rate how competent you feel in assessing and providing each item before and after the course: For the post course rating please rate:- how competent you now feel in assessing and providing each item and confirm that you have seen & tried the equipment if not please explain why 1 = not able; 2 = not sure; 3 = average; 4 = competent; 5 = very Competent. PRESCRIBED LIST EQUIPMENT RAISED TOILET SEAT Precourse rating 1-5 Postcourse rating1-5 COMMENTS TOILET FRAME TOILET FRAME & SEAT COMMODES BATH BOARD BATH SEAT SHOWER BOARD STATIC SHOWER STOOL Page 49 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

51 STATIC SHOWER CHAIR MOBILE SHOWER CHAIR - Standard TROLLEY ZIMMER CADDY PERCHING STOOL CHAIR/BED BLOCKS BED LEVERS (STICK/ LOOP) BED EASY RAIL MATTRESS ELEVATOR PROFILING BED LIFTING POLE GRAB RAILS SMALL EQUIPMENT ORTHOPAEDIC CHAIR WALKING STICK WALKING FRAME WHEELED WALKER SLIP SHEET Page 50 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

52 MOBILE HOIST SLINGS TRANSFER BOARDS For official use only. Pre-Total Post- Total Total divided by 16 Average Average Have you completed the above knowledge and competency ratings? 3. Following the training, what would you now describe as your key roles and responsibilities in relation to the assessment and provision of equipment for the Protocol? 4. In general terms, have your needs in relation to equipment provision for the List, been met by this session? If not, please outline how you feel these could be met? 5. To help us ensure the training format/content for future courses is most effective please describe below. - what you liked - what you would change Page 51 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

53 APPENDIX 4 Module Summary and Learning Outcome Assessment Criteria Information for Managers Module: Joint training on the assessment, provision, fitting & demonstration of extended core list, person assistive equipment and pressure relieving equipment Module Summary Purpose of these modules is for learners to attain the knowledge and skills required to function within the Partnership Protocols and deal with the assessment and provision of the range of equipment included in the training. Learners must have previous knowledge and skills in basic assessment processes. This will be confirmed by their line managers when authorisation is given for attendance at training. For some equipment such as moving and handling products, pressure mattresses etc learners will tend to be qualified professional staff unless they have a checking role within their service The aims are for learners to: be able to explain the core reasons for the protocol and joint working approaches be able to describe their role in relation to the assessment & provision of equipment within the protocol attain the knowledge and skills to assess for, prescribe and demonstrated the use of the equipment covered on the module. Learning Outcome Assessment Criteria 1. Learners must : Understand the core Demonstrate understanding of the benefits of joint reasons for the protocol arrangements for equipment provision within the Partnership. and joint working Demonstrate understanding of the function of the hierarchy approaches within the Partnership and their role within this. Demonstrate understanding of the role of store and delivery staff within the service. Demonstrate understanding of the role of store staff in service, repair and maintenance of the equipment. Demonstrate understanding of their role in providing appropriate information for store and delivery staff to ensure they can provide an effective store service. Demonstrate understanding of joint working with others i.e. other disciplines or agencies. Be aware of the service users care pathway in relation to admission and discharge from hospital and the guidance on roles and responsibilities of hospital and community staff. Understand the importance of good communication with service users, carers, store staff and other services involved. Demonstrate understanding of the responsibility each person in the hierarchy has for maximising use of resources. 2. Understand the role and Responsibilities, Identify the role and responsibilities of an equipment assessor. Demonstrate understanding of the role of formal and informal Risk Assessment within the context of equipment provision. Page 52 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

54 assessment and provision of the range of equipment 3. Fit and demonstrate the use of the Core List equipment. 4. Follow the protocol expectations in relation to follow-up of equipment provision Identify the equipment on the core list and extended lists. Evidence skills in applying equipment to meet client s physical limitations and functional needs Demonstrate sensitivity of service user s views in the decision making process about equipment provision. Identify when to use the equipment and when it is contraindicated Demonstrate understanding of the ethos of minimum intervention maximum independence Demonstrate insight into the benefits of service users being given advice about carrying out tasks differently, and the implications of appropriate non-provision of equipment. Demonstrate insight into the implications for carers of the equipment provision Demonstrate awareness of the constraints of the social environment into which equipment will be installed Demonstrate understanding of service user s mode of communication [Sensory Impairment issues, cognitive barriers] and cultural back grounds. Describe/ demonstrate how equipment can be used safely and the Health and Safety issues requiring consideration. Demonstrate awareness of the constraints of the physical environment into which equipment will be installed. Understand the technical specifications required to fit the equipment Demonstrate knowledge of the interaction of the equipment covered in the module and it s interaction with existing furniture and equipment in the home. Demonstrate insight into the needs of carers learning to use and using the equipment Be aware of Moving and Handling issues related to use of the equipment and the implications for service users and carers Demonstrate awareness of the storage implications of large equipment. Demonstrate understanding of the need to keep accurate records of all interventions including equipment provision. Demonstrate understanding of the need to check effectiveness of the equipment provided Demonstrate insight of the degree of checking that is required i.e. phone check or home visit, referral to another service to carry out this role etc. Demonstrate knowledge about what to do if an incident occurs while service users and carers are using the equipment Be able to explain to service users simple checks to trouble shoot problems that can occur with equipment 5. Understand the policy and procedures for equipment maintenance, repair and replacement Be aware of the Partnerships policy on maintenance, repair and replacement of equipment. Be able to explain equipment cleaning and infection control guidance to service users Be aware of service users responsibilities for their equipment Be aware of the information and documentation provided for service users that refer to maintenance, repair and replacement of equipment. Page 53 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

55 NAEP Training Development Sub-Group APPENDIX 5 Training of Trainers to support an effective training programme Introduction The Scottish Government in its Guidance [Guidance on the Provision of Equipment and Adaptations 2009] promotes the need for standardised training approaches in assessment and provision of equipment. This training pack is an attempt to support organisations that still require to develop or implement effective training programmes. Standardisation of training supports effective and consistent practice which in turn supports appropriate and cost effective equipment provision. Many organisations who are delivering training use their own front line practitioners as trainers. This has implications for frontline services that provide staff for training roles; however this is the most cost effective means to deliver training, is universally adopted by Social Work and Community Equipment Services and also has many other positive outcomes in terms of personal development and interagency communication. The training material should enable front line practitioners to deliver the modules easily and effectively. Selection of training staff Selection of staff to deliver training should be based on those who are already very familiar with the equipment on which the training is based and who will be able to bring significant personal experience of the assessment and prescription of the products. Training material and programme The training manual provided for trainees includes most of the salient points that they need to consider during assessment and provision of the equipment. Additional information should be included about local arrangements and training organisers may want to change the programme offered to meet local needs both logistically and depending on the needs of specific trainees/ teams. The training has 2 main parts:- An introduction to the training session which includes:- information about the local equipment service clarification of the local ethos and protocol within which all staff require to work. general advice about roles and responsibilities within the process of assessing, prescribing and ordering the equipment. And Demonstration of the equipment including:- information about the indications and contra-indications for the equipments application. how it should be fitted a chance for trainees to handle and fit the equipment in a safe situation. discussion in a smaller group about relevant experiences that consolidate the learning. Delivery of the training material Part 1 Introduction The introduction to the course can be delivered by a person who is well acquainted with the local organisation s protocol and has an overview of the equipment service in general. Alternatively those selected to deliver the equipment demonstration could carry out this function. However it has been evidenced that when the delegation of the introductory part of the training may be to any one of several different trainers; the information can be open to interpretation and can change subtly over time. This can lead to inconsistency at the heart of the interpretation of the local protocol, approaches they are encouraged to use and the procedures that staff are expected to observe. However it is noted that in some localities it would be logistically difficult to have 2 different trainers available. Localities need to decide for themselves what is possible in order to deliver effective training. Page 54 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

56 Part 2 Equipment demonstration Trainers can/should familiarise themselves with the material in the training manual and the mode of delivery can be trained using a shadowing method where they observe the approach used by an experienced trainer. This has been effective in localities where a training programme has been developed and bedded in over some years. Trainers are not expected to be identical in delivery and can develop their own preferred manner, however it must be emphasised that the material has to be:- consistent in content taking a set time to deliver most importantly trainers must not pre-assume the level of knowledge that trainees have and subsequently tailor the content by missing out aspects of it. It is unusual for there not to be someone in the training group who has little basic knowledge about the equipment and the trainers must teach to the lowest common denominator within that group. Trainees will not always admit how little they know. It takes time for trainers to develop their confidence and ability to deliver a set amount of information in a logical manner and which offers trainees a framework on which to base their practice in assessment and prescription of equipment. Page 55 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

57 APPENDIX 6 INFECTION CONTROL GUIDANCE Infection Control is now a high priority for the NHS and Social Care services. High quality infection control is essential for the management and monitoring of the infection risk to patients. Quality healthcare is a basic expectation of patients and a challenge to health professionals. Members of the public reasonably expect that patients will not acquire any new disease as a result of their treatment or care. Healthcare Associated Infection therefore is a major concern for the NHS in Scotland as it is for other non NHS establishments. There are two main modes of transmission of organism, via hands or via objects. Micro-organisms are spread via hands through poor hand washing technique. Hands become contaminated with a potentially harmful micro-organism; the micro-organism is not removed through hand washing and is therefore transmitted to a vulnerable patient causing infection. Hands become contaminated through physical contact with either an object or another person carrying the micro-organism The transmission of infection in association with equipment has been recognised as a problem. Inadequate decontamination has frequently been responsible for outbreaks. Safe decontamination of equipment between patients is an essential part of routine infection control The method of decontamination selected should consider the risk of the item acting as a source or vehicle of infection and the process that it will tolerate Manufacturer s guidance on cleaning should be followed Following Inspection Decontamination Guidelines should be adhered to All blood and body fluids should be regarded as potentially infectious The method of cleaning should be consistent with the manufacturer s recommendations including the solutions used Appropriate Protective Clothing should be worn (i.e. gloves, apron and protective eye wear if there is a risk of splashing) Items of equipment marked as SINGLE USE must not be reused or subjected to reprocessing Items of equipment marked as SINGLE PATIENT USE may be decontaminated between uses and only reused on the same patient HANDWASHING The hands of health care staff that have direct patient contact are frequently identified as the most important vehicles for cross-infection. That is why hand washing is often sited as the simplest and most effective method of minimising the potential for the spread of infection. The principles of hand washing technique contained in this document should be applied by all staff. As with all skin surfaces the hands have their own microbial flora. This can be divided into two groups: transient and resident flora. This resident flora forms the normal and permanent microbial population present on healthy skin. Whilst a number of factors can influence the composition of actual strains and species they are for the most part harmless. The transient flora is acquired through contact with contaminants in the environment including patients. The transient flora will normally die off at varying rates but given the right conditions may multiply and go on to colonise the skin. The aim of hand hygiene is; to remove the transient flora and to reduce the numbers of resident flora to safe levels. There are different levels of hand hygiene dependent on the agent used and duration of washing. In most cases it is sufficient to utilise liquid soap applied over a 30 second period (social hand-washing). In some instances an antiseptic hand wash may be required either by using soap with integral antiseptic or an alcohol rub. Page 56 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

58 Social hand-wash Ensure watches and jewellery is removed. Keep finger nails short and clean at all times Turn on and adjust water till it is hot but comfortable Wet hands prior to the application of soap Apply a single dose of soap to the palm of one hand. Vigorously rub soap into all skin surfaces of the hands for a 30 second period. Nail brushes should not be used Rinse all skin surfaces thoroughly in running water until soap has been removed Turn water off taking care to avoid contamination Dry hands thoroughly with disposable paper towel An alcohol hand gel wash can be used where running water is not immediately available For rapid decontamination of the hands when hands are visibly clean In areas where facilities are unavailable or in serious deficit (as in some households in community) Where there has been a heavy inadvertent contamination of the hands alcohol should be used following a social hand wash EQUIPMENT CLEANING GENERAL CONSIDERATIONS Always follow manufacturer s instructions for cleaning, care and maintenance. Equipment should be checked for signs of damage. All equipment should be washed in the industrial washer unless manufacturer s guidance contra-indicates this. Washing equipment by hand will be required otherwise. Wear appropriate protective clothing i.e. gloves, plastic apron and (eye protection if there is a risk of splashing). Use freshly prepared solution. Never pre-dilute detergents and store them. After cleaning rinse items thoroughly with water. M ATTRESSES AND PILLOWS Mattresses and pillows cannot be easily cleaned if they become contaminated. Therefore, if body fluid contamination is likely the mattress and pillow should be enclosed in a waterproof cover. Wiping the cover with a detergent solution and thorough drying usually provides adequate decontamination. Avoid excess wetting during cleaning. PRESSURE RELIEVING APPLIANCES The use of pressure relieving appliances has increased remarkably in the last ten years. There have been a number of reports of isolation of potentially pathogenic micro-organisms from these appliances. There is, therefore, a need to ensure that effective measures are taken to decontaminate such equipment between patients (ICNA Working Group 1998). Clean with hot water and general purpose detergent and dry thoroughly with disposable paper towels. Some covers can be removed and machine washed (check manufactures guidelines) or discarded if heavily soiled. PRESSURE RELIEVING OVERLAYS The system surface should be inspected to ensure it is intact. If tears or perforations are visible the cover should be replaced. The mattress cover can be wiped over using a solution of neutral detergent and hot water. Alternatively the mattress cover can be laundered as per manufacturer s instructions. MISCELLANEOUS EQUIPMENT Toilet frames/seats, commodes, mattress elevators, hoists, bed rails, chairs/ raisers, bathing equipment and walking aids should be cleaned in the industrial washer or with hot water and detergent and dried thoroughly before re-assembly. Page 57 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

59 SLIDING SHEETS Clean using hot water and detergent. Dry thoroughly. ITEMS CONTAMINATED WITH BLOOD OR BODY FLUIDS Disposable gloves should be worn. Place paper towel over any spillage to soak up. Dispose of paper towel into a clinical waste bag. Clean equipment with detergent and hot water and dry thoroughly with disposable paper towels. Dispose of paper towels in a plastic waste bag. References Ayliffe GAJ, Collins BJ, Taylor LJ (1992) Hospital acquired Infection Second Edition. Butterworth Heinemann. Ayliffe GAJ, Coates D, Hoffman PN (1993) Chemical Disinfection in Hospitals Second Edition. Public Health Laboratory Service. ICNA Working Group (1997) Recommendations for the Management of Pressure Relieving Appliances. Page 58 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

60 GUIDELINE FOR SELECTION OF PRESSURE RELIEVING EQUIPMENT August 2012 APPENDIX 7 Primary indicator for pressure relieving equipment from low risk to high risk Unable to move themselves and cannot be repositioned according to need Unable / or find it difficult to move themselves but can be repositioned according to need. Consider matching against following equipment as part of pressure relieving strategy ( including skin release and repositioning) + address risk factors identified thro using Waterlow risk assessment tool 1. Huntleigh Nimbus 3 Alternating air mattress 3 cell cycle nb NOT AVAILABLE NEW 2. Pegasus Cairwave Alternating air mattress NB: NOT AVAILABLE NEW 3. Invacare Softform Premier active mattress NON-STOCK ORDER - See appendix 1 4. Accora Aventia guard non-powered mattress NON-STOCK ORDER See appendix 1 5. Huntleigh Breeze low air loss replacement mattress NON-STOCK ORDER See Appendix 1 1. Repose air mattress - static overlay 2. Harvest Healthcare Royal replacement alternating air mattress high risk 3. Harvest Healthcare Cavalier replacement alternating air mattress Medium risk 4. Sidhill alternating air replacement mattress Medium Risk 5. Huntleigh Alphaexcel alternating air overlay - Medium Risk Able to move him/herself and has no pressure ulcers, but does experience redness over bony prominences for more than 20 minutes after relief of pressure 6. Huntleigh Autologic alternating air overlay - Check with Manufacturer 1. Repose visco-elastic overlay 2. Propad cut foam replacement mattress or overlay Page 59 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

61 Factors that should be considered which may modify decision. N.B. track effectiveness against measurable baselines in particular skin condition, pain, mobility. 1. Person s wishes regarding comfort and preference. 2. Patient independence - There is a need to enhance the person s independence note dynamic equipment may reduce the person s ability to move without help. If possible select static equipment to prevent this especially where he/she is undergoing rehabilitation. Ensure that friction and sheer damage is not made worse. 3. Patient safety. The combination of bed and mattress or bed, mattress and overlay may result in a patient being nursed at too great a height. In particular with community bed, a foam mattress/alternating air mattress overlay may result in a person being too close to the top of bedrails. ( Can be solved by using 3 inch foam overlay instead of foam replacement mattress 4. Patient compatibility. Ensure that the person is not too heavy for the mattress. If they are very light they may find alternating air equipment uncomfortable. If a Repose is not suitable a Low Air Loss mattress could be considered using the special request facility. Bariatric mattresses [SWL > 25 stone] available from the Store. See appendix 1 for details 5. Presenting with pressure ulcer. If person presents with a pressure ulcer consider stepping up from that which would be initially selected in the left hand column. The degree of step up would be influenced by the severity of tissue damage 6. Person develops pressure ulcer. If person presents with a pressure ulcer while on a pressure relieving surface consider upgrading equipment, but review all factors that may be contributing to pressure damage. The degree of step would be influenced by the severity of tissue damage 7. Person s mobility and skin condition improves. Consider downgrading equipment Choice of mattress 1. Use of single or double mattresses is dependent on need and the physical environment and/or social circumstances. 2. If a person s need is low to medium risk it may preferable to provided a Repose static air-filled mattress for use on 1 side off the bed rather than a double cut foam replacement or overlay mattress. The Repose has a low profile and will not result in the person lying at a significantly higher level than their partner 3. A mattress alone will not deal with significant pressure issues and must be provided in the context of the other relevant factors. i.e. unresolved medical issues, mobility, nutrition, personal hygiene or continence. See appendix 2 for specific details Limitations and possible Psychological effects of pressure relieving mattresses Following a holistic assessment of the client and that despite initiating all preventative care, clinical judgement indicates that the client remains at risk of developing pressure damage or has established pressure damage. Staff must be aware that there are many indications and contraindications for prescribing pressure relieving mattresses. Page 60 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

62 The limitations of pressure mattresses can be :- May reduce independent in bed mobility Uncomfortable Some pumps are noisy especially noticeable in small bedrooms If heavier patient may find that air moves when trying to change position pushing them to side of bed (?appropriate use in this instance) Can be difficult for patient to get in and out of bed Risk of falling of the edge of the bed when the edges are less rigid. Moving and handling can be difficult for carers The possible psychological effects of pressure mattresses include:- Chest infections UTI (renal stasis) Constipation (bowel stasis) Oedematous limbs Hypotension Muscle wastage Contracted limbs Loss of confidence Loss of independence Depression Loss of personal contact/touch All the above must be weighed up and a decision regarding prescription made. Page 61 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

63 PRESSURE ULCER PREVENTION AND APPROPRIATE USE OF EQUIPMENT Care Plan Rationale Action Avoid Outcome General Skin Hygiene To maintain skin integrity and moisturise Use of non perfume Soap Aqueous cream Talc Perfumed soap and creams 1. Prevent skin tears and itching Incontinence skin care To maintain skin integrity and acid mantle Timely wash with warm water Cavilon cream for prevention Cavilon spray for treatment of broken skin Barrier creams which require rubbing in to apply and difficult to wash off Talc 2. Maintenance of skin integrity Regular Repositioning To relieve pressure To reduce detrimental and physiological effects For patients well being Prevent contracted limbs Encourage independent movement Assist in requisitioning by appropriate use of moving and handling techniques. Ensure patient mobilises if at all possible Placing patients on bony prominences Leaving patients seated for long periods of time 1. Prevention of pressure ulcers 2. Optimising functional status of patient 30 degree tilt To spread weight over as great a surface areas as possible Reduce friction and shearing forces at repositioning Increase patient comfort Position patient in a 30 degree tilt to ensure weight is not concentrated on bony prominences Maintain position with use of pillows Always roll patient into position do not lift to prevent injury to patient by friction and shear and injury to those carrying out the procedure. Avoid lifting patient into position If pillows are removed the patient should roll onto their back. If they remain in position they have been positioned round too far 1. Prevention of pressure ulcers and bony prominences. 2. Patient is comfortable 3. Frequency of repositioning during the night may be reduced. Releasing the skin To ensure the skin is not tight and increased risk of shearing forces when repositioning This includes when seated in bed Following repositioning slide hands under buttocks, shoulder and spine and bounce skin gently to release the skin. Ensure patient and bed clothing is also loose. Positioning patient on seating which is too high or sitting up in bed whereby the patient may slide down and increase risk of shearing forces 1. Prevention of shearing force damage 2. Promote patient comfort Use of appropriate moving and handling techniques/equipment To ensure pressure damage does not occur due to friction or shearing forces Follow moving and handling guidelines on appropriate use of equipment and techniques Lack of appropriate technique increase the risk of pressure ulcers due to friction and shearing forces Risks injury to the carers 1. Maintenance of skin integrity 2. Comfortable for the patient 3. Easier for staff/carers Use of static foam support surfaces To reduce the risk of pressure damage in conjunction with a individualised care plan Following patient assessment and clinical judgement order mattress/overlay Not to be used in place of nursing care 1. Maintenance of skin integrity 2. Promote patient independence and comfort Use of repose mattress/heel boots To reduce risk of pressure damage Treatment as part of individualised care plan Following patient assessment and clinical judgment Order equipment from Equipu Not to be used as a substitute for patient repositioning 1. Maintenance of skin integrity 2. Promote patient independence and comfort Use of dynamic mattress To reduce risk of pressure damage in immobile patient Treatment as part of individual care Following patient assessment and clinical judgment Order equipment from Equipu Not to be used as a substitute for patient repositioning 1. Maintenance of skin integrity 2. Promote patient independence and comfort Page 62 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

64 SAMPLE PRODUCTS Optional mattresses for provision when current stock products are unsuitable or unavailable Softform Premier active mattress The Invacare Softform Premier Active mattress features an alternating air insert beneath castellated foam This mattress has a 'High/Very High Risk'* static surface, but should a patient require stepping up to a dynamic surface, a pump can be fitted to the air insert, transforming the mattress into an alternating surface delivering additional levels of pressure relief. There is no requirement to transfer the client which minimises discomfort. The air cells alternate on a ten minute cycle beneath the foam insert, delivering a very low impact at the point of change, thereby delivering high levels of comfort in addition to improved pressure reduction. Pump automatically assesses patient weight enabling pressure to be maintained accordingly at an appropriate level. The pump is also fully alarmed in case of power failure or fault. The mattress had a Two-way stretch cover and conforms to the deep contoured castellations on the upper surface of the mattress, minimising rucking and further reducing the potential for tissue. SWL 39 stones. Price [Guideline only] Accora Aventia Pressure Guard non-powered mattress Static air mattress with shaped, slotted inner bolsters/cylinders and topper with underside arches which work to cradle and surround air cylinders. Interlocking, integrated design provides flexible, progressive support and maximizes structural integrity. Firmer perimeter bolsters prompt patient toward centre of bed without awkward build-ups that obstruct entry and egress. Facilitates safer transfers and stable edge-of-bed sitting. Heel Slope feature redistributes load to pressure-tolerant lower legs and calves. Subtle taper reduces heel pressures while providing complete foot support. Vapour barrier 2 way stretch cover. Page 63 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

65 Huntleigh Breeze replacement low air loss mattress The Breeze Low Air Loss Mattress Replacement and Mattress Overlay Systems provide excellent pressure redistribution offering both a mattress replacement and mattress overlay system. The Breeze incorporates a unique turn valve deflation feature that allows key cells to be deflated under the heel for those patients at greatest risk of heel ulceration. The Breeze combines continuous low pressure support with optimum user comfort for patients unable to tolerate a moving surface or those who feel more secure and comfortable on a non-alternating surface may benefit from low air loss therapy. This can include children for whom the standard cells which alternate are too large to accommodate their small bodies and they fall into the deflated cell rather than lying over the gap. SWL kg (310 lbs / 22 stone) Price on enquiry Equipu Stock Bariatric Mattresses * For Prescription by Community Nursing staff only 1. Sidhill Acclaim Bariatric VE Foam mattress [117x203x15.2cm] Dynamic cells plus foam underlay - swl - 50st/ 317.5kg Product Code: MAT/ACCL/VE/BAR Price [guide only] Sidhill bariatric dynamic mattress [115x204x22cm] - swl - 45st/ kg Product code: DYN/BAR Price [guide only] Alternative static mattress Days Primo bario static pressure mattress swl - 63st/ 400kg Non-stock item Price [Guide only] Page 64 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

66 ORTHOPAEDIC CHAIRS APPENDIX 8 Items of furniture are not supplied under the Chronically Sick and Disabled Persons (Scotland) Act Chairs are not, therefore, routinely issued as they are seen as an item of normal household furniture. However staff should follow the local arrangements which guide the provision of these. DESCRIPTION Chairs with a firm posturally supportive seat and back. Adjustable seat height which makes it possible for a chair to be adapted to be used by several different people. Often provided with vinyl seat covers for ease of recycling. SAFE WEIGHT LIMIT Must be checked for each user - specific to the chair provided as this can vary. ALTERNATIVES Alternative method taught for transferring from sitting standing sitting Alternative chair within the house Chair raising unit 4 cushion on top of existing cushion - only suitable if the existing cushion is in good condition Users agrees to purchase own chair of the specification recommended by the assessor CRITERIA/GUIDELINES FOR PROVISION Current local criteria for service provision are met Other simpler seating solutions have been considered. CONSIDERATIONS Depth and width of the required chair have been measured. Unless there is another appropriate chair available in the house, the preferred option will be to raise the person s existing chair if it is suitable apart from its height. CONTRA-INDICATIONS The user requires a more supportive seat with additional lateral support The user requires pressure relief due to skin integrity issues basic cushioning is inadequate for this. The user has skin integrity issues that require back and seat angle to be variable The user requires a riser/recliner to support transfers from sitting to standing Page 65 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

67 APPENDIX 9 MINOR HOUSEHOLD/PERSONAL CARE EQUIPMENT As a general rule the private purchase of smaller, mainstream household and personal care equipment should be encouraged. Essential eating/drinking equipment and equipment to support joint preservation or to comply with post-op precautions can continue to be issued, following appropriate assessment, as part of an agreed treatment plan. Rehabilitation and Reablement staff can provide this under local agreements, to support their intervention. FOOD PREPARATION EQUIPMENT Description Various devices are available to make food preparation easier and safer e.g. jar openers, easigrip knives/scissors, knob turners, cooking baskets and kettle tippers. When should this equipment be issued? The item is essentially required for joint protection or safety reasons The item(s) cannot be readily purchased locally. Considerations Devices which hold the kettle to provide support when tilting and pouring can be cumbersome in a small kitchen. The kettle remains on the tipper whilst boiling and needs to be filled using a jug. The tipper should be checked to ensure it is suitable for style of kettle in use as many will not accommodate cordless models. A smaller travel kettle may be more appropriate. EATING and DRINKING EQUIPMENT Description Specially designed eating and/or drinking equipment may help service users to maintain independence. These may include cutlery with larger or angled handles, lipped/angled plates, alternative drinking cups/beakers or straws. When should this equipment be issued? The items are essentially required to maintain a degree of personal independence and The item(s) cannot be readily purchased locally. Considerations A contoured surface can sometimes be added to the handle of a piece of existing cutlery to facilitate grip and enhance comfort. Cutlery with short handles may facilitate control. However, long handles may extend the range of movement. Partially sighted users may find it helpful to have cutlery/cups/plates in a colour that contrasts with the background. Colour contrast, either in the form of a coloured vessel or a coloured line through a transparent glass or beaker, may be easier for a user who is partially sighted. A wide based drinking cup is more stable. A cup lid may help to prevent spillage. Large handles allow users to put their hands right around the handle, which may facilitate a more secure grip - 'D', 'T' and 'J' shaped handles provide a variety of grips for users with reduced range of movement or strength. An unbreakable, ribbed cup/glass may be easier to grip and be less likely to cause injury if dropped by the user. A large cup/glass can be half filled to reduce the risk of spillage, but still provide a good sized drink. Standard crockery can often be adapted to make it easier to use, e.g. by adding a plate guard. Service users who are partially sighted may prefer a plate or bowl that provides a colour contrast between the background and the food itself. Modern picnic ware can be lightweight, unbreakable and contemporary in design and may be a more acceptable alternative in some cases. Page 66 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

68 DRESSING/WASHING EQUIPMENT Description Long handled brushes, combs, sponges and shoe horns can be used to extend reach. Gutter hosiery equipment can help putting on socks, stockings or tights. A dressing stick is typically a length of wooden dowelling which is rounded at the ends and has a rubber thimble and hook attachment - the dowelling can be cut to a length that suits the needs of the person using it. Button hooks are useful for those lacking fine finger dexterity, or who only have the use of one hand. These are pushed through the buttonhole and looped over the button, then pulled back through the buttonhole with a slight twist, holding on to the button. When should this equipment be issued? The items are essentially required to maintain a degree of personal independence and The item(s) cannot be readily purchased locally. Considerations Stocking aids require practice as they can be difficult to use. People with poor grip or shoulder function may find pulling the tights up over the hip difficult. Pulling up with hands crossed over the body reduces the amount of shoulder movement required. A dressing stick can help bring the clothes round, or push garments off the shoulders, pull up zips (using the hook end, tighten or loosen shoe laces, push clothes down (for example pants or stockings) and pull up straps. Button hooks need quite a lot of practice, particularly when using them with one hand. However, it helps if the edges of the garment can be held steady, and if the buttonhole is on the person's most able side. Page 67 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

69 APPENDIX 10 LIFTING POLES DESCRIPTION WEIGHT RESTRICTIONS Alternative Provision Lifting poles can be either free-standing or ceiling fixed and provide a suspended lifting handle over the bed stones/ kg Check Safe Weight Limits for usage as these can change. Bed levers/sticks may be more suitable for helping to change position in bed. Considerations prior to issue Service user is unable independently to get into a sitting position from lying down Other standard equipment has been considered and deemed to be inappropriate. Service user has difficulty turning. Service user has sufficient strength in upper limb(s) Ensure equipment is acceptable to service user and/or other family members When should this equipment be used? A Lifting pole may allow person to raise self up sufficiently in bed to move self up bed or, Allow for bedpan to be positioned for use underneath Contra Indications for use Severe cardiac problems. Severe chest problems. Upper limb girdle dysfunction e.g. Rheumatoid Arthritis, Muscular Dystrophy. Severe hemiplegia. Where there is any possibility of shoulder dislocation or spinal strain. Where there is a risk to pressure areas from potential drag effect. Where there are any signs of a confused state. Adjustments Ensure that strapping is adjusted to suit individual prior to issue. Checks Prior to use Ensure the strapping is firmly attached to grab handle prior to use. Ensure user is comfortable using over a prolonged period while in bed. Maintenance Equipment should be cleaned in accordance with manufacturer recommendations. Page 68 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012

70 COMPLEX MOBILE SHOWER / COMMODE CHAIRS Tend to be non-stock products APPENDIX 11 Examples of shower/toileting chairs and bariatric and tilt-in-space versions Check Safe Weight Limits for usage as these are all different and can change. DESCRIPTIONS Mobile shower/commode chairs are a more complex provision for those users whose needs extend beyond the basic static shower chair or shower/commode chair. Those pictured above are examples of modular products and/or have a variety of components or features. These are prescribed after full assessment by an appropriate assessor and can include:- A variety of sizes height and width including bariatric versions Suitability for use over toilets/commodes and in showers Integrated commode pan Detachable commode apron Padded seats with full padding, padded ring or horse shoe apertures in different sizes Different styles of push handles A range of length adjustable foot rest options including swing away or with toe/heel straps or sandals Specialised leg rests Straight or angled arm rests Hooped, swing away or detachable arms rest for side ways transfers Attendant or self propelled versions with appropriate brake mechanisms Quick release wheels and disassembly for easy transportability One handed self-propelled wheels. Large front wheels/small back wheels for use with i.e. double amputees due to changed weight distribution. Tilt in space facility with extended head rest A range of available straps and harnesses/ pommels/ extra padding/head supports etc Alternatives Standard available static shower seats / basic wheeled shower commode seat / showering table / bespoke shower units/ adapted baths. Considerations prior to issue Following full functional and physical assessment, limitations have been identified which basic chairs cannot accommodate Has the user issues with i.e. spasms/ un-controlled epilepsy/un-controlled movements which would make the chair unsafe for them? Has the user reduced skin sensation/ proprioceptive loss that require protective measures? Would a more basic shower/commode chair suffice? Would a fixed shower seat be more suitable or safer? Would bathing using an adapted bath be safer? Space available in the shower area for user as well as equipment, particularly seats in shower cubicles? Check shower chair will fit inside shower cubicle/area before ordering Is the seat large enough to accommodate the user s girth without becoming trapped between the arm rests? Shower chairs plus user weight can cause significant loading on some shower bases Presence of an even surface to stand the equipment on Orientation in the shower area and proximity of shower screens to user s legs Does the equipment assist the user to participate in washing themselves if this is appropriate? Access to shower controls Accurate user weight identified and safe weight limits observed Carer s ability to cope with the equipment Would the user be alarmed due to cognitive issues, by attendant controlled movement of the chair i.e. the tilt in space mechanism The needs of other people using the shower area Storage of the equipment when not in use Interaction with other equipment i.e. hoists/standaid and related slings/closomat toilet Does the equipment accommodate allow/support appropriate Moving and Handling activity. Has an urgent need been identified? i.e. in cases of palliative care/end of life situations N.B. Non-stock orders can take time to arrive Page 69 of 69 NAEP Scottish Training Sub Group - Core Equipment Training Manual: Updated October 2012